COMPLICATIONS OF SHORT-TERM INTUBATION

Laryngoscopy

When the laryngoscope is used improperly, when laryngoscopy is particularly difficult, or when there is dental or periodontal disease, teeth may be injured. If a tooth is chipped or partially broken, the fragment should be located but cannot be reaffixed to the natural tooth. If an entire tooth is dislodged, the tooth should be carefully handled without touching the root. Dental consultation should be obtained to reaffix the tooth in its socket. If such consultation is not available, the tooth can be placed in saline or milk until dental expertise can be obtained. If fragments or whole teeth cannot be located, chest and abdominal radiographs should be obtained for localization.

The laryngoscope can also injure the soft tissues, usually the lips or gums, but any area of contact can be injured. These injuries are more likely to occur when intubation is difficult and the finer points of technique are sacrificed to expedite intubation. The details of the injury should be well documented in the anesthetic record and chart and the patient informed of the injury.

When laryngoscopy is performed under inadequate anesthesia, coughing, laryngospasm, bronchospasm, and vomiting (with the possibility of aspiration) may occur. Cough should be especially avoided in the settings of an open-eye injury, increased intracranial pressure, or an intracranial vascular anomaly. Laryngospasm should be treated with oxygen, jaw thrust, and gentle mask pressure but may require muscle relaxants to avoid a period of severe desaturation. If the patient has cervical spine disease due to traumatic, congenital, inflammatory, or neoplastic disease, the spinal cord can be injured during neck movement.^[45] Eye trauma may be caused by accidental injury with an instrument or by the laryngoscopist.