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Letters to Editor 3.
McGinley J, McAdoo J. Airway adjunct to an unanticipated difficult airway. Anesth Analg 1999;88:467-8. Access this article online Quick Response Code:
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DOI: 10.4103/0019-5049.76579
Metallic foreign object in postoperative chest radiograph? Sir, Figure 1: Guedel’s airway with slit on the palatal surface of the airway
to the deficiency in anterior support. Oral airways with a posterior channel, such as the Ovassapian and Berman, facilitate easy fibreoptic oro-tracheal intubation. Each can be rapidly removed from around the tracheal tube except for Burman’s airway as it has both posterior and lateral channels.[1] We have done a pilot study comparing both lingual and palatal modifications of Guedel’s airway and found that the palatal modification of Guedel’s airway makes FFLI easy, keeps the FFL in midline, no addition manoeuver like jaw thrust is required and causes no disturbance of endotracheal tube–laryngoscope assembly. A possible limitation of the modification would be lack of standardisation. Geudel’s airway is available in many sizes as compared to other FCOAs, making it versatile, cost-effective and highly acceptable.
A 63-year-old male underwent beating heart coronary artery bypass surgery at our institute. Post procedure, the patient was shifted to Cardiac Recovery with endotracheal tube, Swan Ganz catheter and femoral arterial cannula in situ. The procedure was completed uneventfully, with complete counts of all the materials used by the surgeon for the surgery. The on-duty resident found a radio opaque coiled wire like shadow lateral, to the right sternal border in the third intercostal space (ICS) on a post operative chest radiograph anteroposterior view [Figure 1]. The presence of this unique foreign body raised a suspicion. At the first instance the possibility of a metallic object being left in was thought of, but it was ruled out on the
Vanita Ahuja, Virender K Arya1, Babloo Kumar Department of Anaesthesia & Intensive Care, Government Medical College and Hospital, Sector-32, 1Postgraduate Institute of Medical Education and Research, Chandigarh, India Address for correspondence: Dr. Vanita Ahuja, 813, Sector-7, Panchkula - 134 114, India. E-mail:
[email protected]
REFERENCES 1. 2.
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Dorsch JA, Dorsch SE. Face masks and airways. In: Dorsch JA, Dorsch SE, editors. Understanding Anesthesia Equipment. 5th ed. Baltimore, USA: Williams and Wilkins; 2008. p. 443-59. Gal TJ. Airway management. In: Miller RD, editor. Miller's anesthesia. 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2005. p. 1617-52 .
Figure 1: Chest radiograph showing metallic object lateral to the right sternal border Indian Journal of Anaesthesia | Vol. 55| Issue 1 | Jan-Feb 2011
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Letters to Editor
Dheeraj Arora, Abhishek Bansal, Yatin Mehta Medanta Institute of Critical Care and Anaesthesiology, Medanta — The Medicity, Gurgaon, India Address for correspondence: Dr. Yatin Mehta, Medanta Institute of Critical Care and Anaesthesiology, Medanta — The Medicity, Gurgaon, Haryana, India. E-mail:
[email protected]
REFERENCES 1. 2. 3.
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Figure 2: Chest radiograph showing metallic object above the right clavicle
assurance of the surgeon and the assistant operating staff. On physical examination no metallic object was found on the patient’s chest. The digital chest X-ray was repeated. The repeat radiograph showed the same foreign body lying on the right side of the neck, above the clavicle, with a clear demarcation of the pilot balloon [Figure 2]. Thus, diagnosis of pilot balloon of the tracheal tube and its spring loaded valve falsely appearing as a foreign body was made. Artefacts can commonly be seen in a chest X-ray film. However, the familiarity and knowledge of various surgical materials like vascular clips, stents, sternal wires, needles, intra-aortic balloon catheter tips and so on, can help clinicians in differentiating these from the artefacts. Also the knowledge of some common radio opaque structures, which may appear as artefacts should also be kept in mind. Chakarabarthy and others reported radio opaque rings seen in the post off-pump coronary artery bypass chest radiograph as epidural connectors. [1] Arora and others reported the hearing aid of a patient appearing as a pacemaker on an X-ray.[2] As any surgical mishap such as wires, shunts, sponges and so on can have catastrophic consequences and medicolegal implications,[3] early recognition of such events is warranted, using other imaging modalities if need be. Adequate knowledge and cautious reading and reporting of X-rays may prevent unnecessary interventions. The pilot balloon may be secured along with the tracheal tube, particularly in patients undergoing cardiac surgery or requiring prolonged ventilation, so that it does not mislead the clinician. Indian Journal of Anaesthesia | Vol. 55| Issue 1 | Jan-Feb 2011
Chakravarthy M, Patil TG, Jawali V, Jayaprakash K, Shivananda N. Radio-opaque foreign body on a postoperative chest X-ray. J Cardiothorac Vasc Anesth 2004;18:673-4. Arora D, Mehta Y. An unidentified object in the chest? J Cardiothorac Vasc Anesth 2008;22:930-1. Wolfson KA, Seeger LL, Kadell MB, Eckardt JJ. Imaging of surgical paraphernalia: What belongs in the patient and what does not. Radiographics 2000;20:1665-73.
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DOI: 10.4103/0019-5049.76576
Popliteal artery thrombosis following total knee arthroplasty: A preventable complication with surveillance Sir, We are reporting a case of popliteal artery thrombosis after total knee arthroplasty (TKA). A 60-year-old ASA Grade II hypertensive female patient was admitted for bilateral total knee arthoplasty. Surgery was conducted under combined spinal and epidural anaesthesia and Propofol infusion. Tourniquet time was 56 min on right side and 66 min on left side with a pressure of 300 mmHg. Intraoperative period was uneventful. Postoperatively patient was shifted to the intensive care unit (ICU) as per hospital protocol for pain management and monitoring where she remained comfortable and stable. Epidural infusion (Bupivacaine 0.125% and Clonidine 2 µg/ml) was started at the rate of 6 ml per hour. On examination the left dorsalis pedis and posterior tibial artery pulsation were absent with normal left femoral artery pulsation. Toes on the left 85
