P038: ANESTHETIC MANAGEMENT FOR UNANTICIPATED ASYMPTOMATIC PHARYNGEAL MASS DURING FOOD IMPACTION
Harshvardhan Rajen, MD; James Morrow, MD; Sophia Fischer, MD; Kendall Regional Medical Center
Introduction/Background: The patient is a 47 year old male with no significant contributory past medical history who presented to the emergency department approximately 2 hours after ingesting food and developing pain and trouble swallowing. He was promptly evaluated by gastroenterologist and the diagnosis of food impaction was determined and the patient was scheduled for emergent endoscopy.
Methods: Rapid sequence induction and intubation was attempted with fentanyl, propofol, succinylcholine and cricoid pressure held to minimize risk of aspiration. On introduction of the laryngoscope blade to the oropharynx there was unexpected difficulty in visualizing the vocal cords due to multiple exophytic friable masses located in the right piriform sinus and subglottic space obstructing the view of the vocal cords. An attempt to intubate the patient with direct laryngoscopy was attempted and subsequently unsuccessful. A second attempt was made with a video laryngoscope to visualize the vocal cords and successfully pass the endotracheal tube through vocal cords.
Results: Once the airway was secured the gastroenterologist then proceeded with endoscopy and retrieval of impacted food in lower esophagus. Biopsies were taken of the pharyngeal masses and sent to pathology. The patient was then successfully extubated. The pathology results of the biopsies were determined to be squamous mucosa with chronic inflammatory infiltrate with no evidence of lymphoproliferative disease and the patient was referred to an otolaryngologist.
Discussion/Conclusion: The unanticipated difficult airway by its very nature is difficult to predict. Therefore careful planning and anticipation must be taken with the administration of every single anesthetic, as the inability to manage a difficult airway can lead to negative patient outcomes, including hypoxic injury and death.