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Placement of a nasogastric tube (NGT) preoperatively for decompression of the stomach is common practice to allow drainage of gastrointestinal contents in the case of bowel obstruction, or in other cases when the patient is at risk of aspiration for some other reason. This case report involves a patient who required aspiration precautions via NGT placement for mandibular surgery due to facial trauma; the NGT was later found to be misplaced in the left main stem bronchus as the misplacement was unrecognized intraoperatively. We discuss the

, 110 Meperidine, 14, 91 Meta-analysis, 57 Midazolam, 25, 64, 91 Misplacement, 114 Monitor, 100 Morphine, 91 Nasal trumpet, 166 Nasogastric tube, 114 Nasopharyngeal airway, 166 Nasotracheal intubation, 122 Needle, 2 Nonrestrictively, 100 Noonan syndrome, 71 Oral surgery, 114 Oral tissue blood flow, 51 Oral tumors pediatric anesthesia, 118 Orthognathic surgery, 166 Outpatient anesthesia, 25 Pain, 2, 46, 106, 153

received training and subsequently performed cricothyrotomy by 3 techniques: surgical, Melker, and QuickTrach II. The time to complete the procedure, rate of success, and number of complications were recorded. The success rates were 95%, 55%, and 50%, respectively, for surgical cricothyrotomy, QuickTrach, and Melker ( p = .025). Most failures were the result of cannula misplacement in the nonsurgical techniques. Although these results favor surgical cricothyrotomy for trained medical personnel, several limitations of the study are discussed by the authors including the

also cause complications. There are some underlying factors that contribute to significant knotting. Blind insertion can lead to NGT misplacement, at an estimated rate of 1.2% to 2.3%. 11 Moreover, NGT malpositioning tends to recur in 13% to 32% of subsequent repositioning attempts. 12 These unfavorable conditions collectively increase the risk of NGT complications. Figure 3. Model used to theorize how the nasogastric tube (NGT) might have become knotted around the nasal tracheal tube (NETT). (A) The NGT folded and turned

patients may experience a significant tracheopulmonary complication, such as pneumothorax, even if the misplaced NG tube is identified immediately. 4 Indeed, in Rassias's 4 prospective study of ICU patients who experienced tracheopulmonary malpositioning of NG tubes, all patients received chest radiographs, but the radiographs were misinterpreted in 2 of the 14 cases. Bedside chest radiographs are convenient and have become the mainstay for monitoring the respiratory status of hospital patients, especially those in intensive care units. Unfortunately, proper

of an LMA. 13 Therefore, this appears to be the first case report regarding the introduction of a fallen tooth into the airway or esophagus in association with insertion of an LMA. Anticipating potential problems that may arise and developing appropriate management or contingency plans are critical aspects of any anesthetic plan. For a nonintubated patient, a misplaced foreign body occluding the airway is likely to cause sudden and serious deterioration of normal respiratory functionality. Whenever inclusion of a foreign body is suspected and cannot be

later examination revealed that improper mounting of the inner partition of the canister had resulted in ineffective CO 2 absorption. The trouble was caused by misplacement of the inner partition in the upside-down position, causing expiratory gas to bypass the sodalime to the inspiratory outlet in the canister. No gas leakage could be found in the positive pressure examination of the anesthetic circuit including the canister after rearranging the inner partition and fresh sodalime. Such trouble cannot be discovered by following the routine preoperative checklist of