Anesth Pain Med.  2016 Jan;11(1):104-108. 10.17085/apm.2016.11.1.104.

The oropharyngeal bleeding after esophageal stethoscope insertion: A case report

• Cho K
• Kim MH
• Lee W
• Lee JH
• Lim SH
• Lee KM
• Kim YJ
• Kim JH
• Choi DN
• Chang HY

• KMID: 2169084
• DOI: http://doi.org/10.17085/apm.2016.11.1.104

Abstract

The daily insertion of endotracheal tubes, laryngeal mask airways, oral/nasal airways, gastric tubes, transesophageal echocardiogram probes, esophageal dilators and emergency airways all involve the risk of airway structure damage. In the closed claims analysis of the American Society of Anesthesiologists, 6% of all claims concerned airway injury. Among the airway injury claims, the most common cause was difficult intubation. Among many other causes, esophageal stethoscope is a relatively noninvasive monitor that provides extremely useful information. Relatively not many side effects that hardly is ratable. Some of that was from tracheal insertion, bronchial insertion resulting in hypoxia, hoarseness due to post cricoids inflammation, misguided surgical dissection of esophagus. Also oropharyngeal bleeding and subsequent anemia probably are possible and rarely pharyngeal/esophageal perforations are also possible because of this device. Careful and gentle procedure is necessary when inserting esophageal stethoscope and observations for injury and bleeding are needed after insertion.

Keyword

Airway injury; Esophageal stethoscope; Oropharyngeal laceration

MeSH Terms

Anemia
Anoxia
Emergencies
Esophagus
Hemorrhage*
Hoarseness
Inflammation
Insurance Claim Review
Intubation
Laryngeal Masks
Stethoscopes*

Figure

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  Fig. 1 Oropharyngeal bleeding.

Reference

1. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology. 2013. 5th ed. New York: The McGraw-Hll companies;p. 1211–2.

2. Domino KB, Posner KL, Caplan RA, Cheney FW. Airway injury during anesthesia: a closed claims analysis. Anesthesiology. 1999; 91:1703–11. DOI: 10.1097/00000542-199912000-00023. PMID: 10598613.

3. Schwartz AJ, Downes JJ. Hazards of a simple monitoring device, the esophageal stethoscope. Anesthesiology. 1977; 47:64–5. DOI: 10.1097/00000542-197707000-00013.

4. Manecke GR Jr, Poppers PJ. Esophageal stethoscope placement depth: its effect on heart and lung sound monitoring during general anesthesia. Anesth Analg. 1998; 86:1276–9. DOI: 10.1097/00000539-199806000-00027.

5. Kim JS. Anesthesia and temperature. Korean J Anesthesiol. 2004; 47:609–16.

6. Goto H, Hackman LT, Arakawa K. Tracheal insertion of an esophageal stethoscope. Anesth Analg. 1977; 56:584–5. DOI: 10.1213/00000539-197707000-00032.

7. Pickard WA, Reid L. Hypoxia caused by an esophageal stethoscope. Anesthesiology. 1986; 65:534–6. DOI: 10.1097/00000542-198611000-00018.

8. Friedman M, Toriumi DM. Esophageal stethoscope. Another possible cause of vocal cord paralysis. Arch Otolaryngol Head Neck Surg. 1989; 115:95–8. DOI: 10.1001/archotol.1989.01860250097035. PMID: 2909236.

9. Cook TM, Scott S, Mihai R. Litigation related airway and respiratory complications of anesthesia: an analysis of claims against the NHS in England 1995-2007. Anaesthesia. 2010; 65:556–63. DOI: 10.1111/j.1365-2044.2010.06331.x. PMID: 20345420.

10. Bahk JH, Ahn WS, Lim YJ. Use of esophageal stethoscope as an introducer during nasotracheal intubation. Anesthesiology. 2000; 92:1503–4. DOI: 10.1097/00000542-200005000-00059. PMID: 10781307.

11. Kim SH, Jang DM, Park JH. Nasogastric tube placement using a semi-rigid esophageal stethoscope in an intubated surgical patient. Korean J Anesthesiol. 2014; 66:407. DOI: 10.4097/kjae.2014.66.5.407. PMID: 24910736. PMCID: PMC4041963.