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LETTERS TO EDITOR
Year : 2021  |  Volume : 65  |  Issue : 4  |  Page : 337-338  

An unrecognised risk in endotracheal intubation by a Truview laryngoscope


Department of Anaesthesia, Lady Hardinge Medical College and Smt Sucheta Kriplani and Kalawati Saran Children's Hospital, New Delhi, India

Date of Submission22-Aug-2020
Date of Decision08-Oct-2020
Date of Acceptance21-Dec-2020
Date of Web Publication15-Apr-2021

Correspondence Address:
Raksha Kundal
Department of Anaesthesia, Lady Hardinge Medical College and Smt Sucheta Kriplani and Kalawati Saran Children's Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_1137_20

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How to cite this article:
Singh P, Kundal R, Sharma N, Pandey M. An unrecognised risk in endotracheal intubation by a Truview laryngoscope. Indian J Anaesth 2021;65:337-8

How to cite this URL:
Singh P, Kundal R, Sharma N, Pandey M. An unrecognised risk in endotracheal intubation by a Truview laryngoscope. Indian J Anaesth [serial online] 2021 [cited 2021 Jun 14];65:337-8. Available from: https://www.ijaweb.org/text.asp?2021/65/4/287/313857

Sir,

The Truview EVOTM laryngoscope (Truphatek International Ltd., Netanya, Israel) is a commonly used video laryngoscopy device in both adult and paediatric anaesthetic practice. It is especially useful in preterm or low birth weight neonates in whom conventional laryngoscopy may be difficult due to the anterior location of the larynx.[1] This laryngoscope has its proprietary stylet (OptishapeTM stylet) for proper control of the endotracheal tube during intubation. While preparing for the anaesthetic induction of a preterm neonate who was to be operated for biliary atresia, we came across a serious issue with the stylet which could have led to a major complication. As a routine practice at our hospital, a preliminary check to ensure the functional status of instruments to be used during induction of anaesthesia is performed. This includes a close inspection of the Truview EVOTM laryngoscope and its stylet as issues with this device have been reported earlier.[2] During our inspection, we found that when trying to remove the stylet (Optishape No 410000 meant for ETT size 2.5-3.5) [Figure 1] from the endotracheal tube (Size 2.5 uncuffed), the distal wire end of the stylet continued to remain inside the lumen of the endotracheal tube while the proximal part of the stylet came out. As this inspection was being carried out on the anaesthetic table, we were able to visualise the distal wire lying within the endotracheal tube [Figure 2]. Had we not performed this test and gone ahead with intubation, this wire would have remained inside the endotracheal tube and subsequently upon ventilation, may have moved down into the airway. As this wire is supposed to be a part of the stylet, the anaesthetic team would not have realised that it had inadvertently introduced a foreign body into the lung. As tracheobronchial foreign bodies are associated with complications like bronchospasm, pneumonia, atelectasis, pneumothorax and potential mortality, this event could have grave consequences and may have required bronchoscopy or surgery for its management.[3]
Figure 1: OptishapeTMstylet (no. 410000) for ETT size 2.5-3.5

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Figure 2: The endotracheal tube (2.5 uncuffed) with the distal wire of the stylet in its lumen and the OptishapeTMstylet after removal

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Our literature search revealed only one other case of Optishape stylet malfunction in which the authors were unable to withdraw the stylet after intubation.[2] However, the dislodgement of the stylet wire as observed in our case has not been reported earlier. It is possible that what we experienced was a manufacturing defect peculiar to the stylet supplied to us as this was the very first use of the new stylet, and hence, wear and tear could not explain this event. Although we have informed the manufacturer regarding our experience, it may be beneficial to check the integrity of the stylet by inserting and removing it out of the endotracheal tube prior to attempting intubation with this device. This can prevent a serious and unforeseen complication of intubation using this device.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Singh R, Singh P, Vajifdar H. A comparison of Truview infant EVO2 laryngoscope with the Miller blade in neonates and infants. Paediatr Anaesth 2009;19:338-42.  Back to cited text no. 1
    
2.
Anand L, Sunita, Kapoor D, Sarna R. Unable to withdraw the Optishape[TM] stylet during endotracheal intubation: An unusual cause. APSF Newsletter 2013;28:47.  Back to cited text no. 2
    
3.
Kalyanappagol V, Kulkarni N, Bidri L. Management of tracheobronchial foreign body aspirations in paediatric age group - A 10 year retrospective analysis. Indian J Anaesth 2007;51:20-3.   Back to cited text no. 3
  [Full text]  


    Figures

  [Figure 1], [Figure 2]



 

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