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The Bullard laryngoscope and uvular edema

Winnipeg, Manitoba

To the Editor:

We would like to report a case of uvular edema complicating endotracheal intubation with the Bullard laryngoscope. A 56-yr-old male presented for a sigmoid colectomy for carcinoma of the colon. There was no recent history of an upper respiratory tract infection and he was a non-smoker. His past surgical history included bilateral laparoscopic inguinal hernia procedures. The trachea was successfully intubated for this surgery using a Macintosh blade. Only the tip of the epiglottis was visible. The airway examination revealed a Mallampati 2 score, normal mouth opening, mentohyoid distance greater than 5 cm and good jaw mobility. He underwent general endotracheal anesthesia with rocuronium used to facilitate muscle relaxation. A size 8.0 Mallinckrodt endotracheal tube (ETT) was easily inserted at the first attempt utilizing the Bullard laryngoscope with extender blade tip and a multifunctional stylet. A Cook airway exchange catheter was passed between the cords and the ETT railroaded under direct vision into the trachea. The ETT position was confirmed clinically and by end-tidal capnography. The surgical procedure was completed in 75 min. After careful blind suctioning, reversal of neuromuscular blockade with neostigmine and glycopyrrolate, the patient was extubated awake. A nasogastric tube was not inserted. In the recovery room and on the first postoperative day the patient complained of a severe sore throat. The initial symptoms were attributed to the intubation and, given no clinical evidence of airway compromise, no further action was taken. Inspection of the pharynx on the first postoperative day revealed a markedly swollen hyperemic uvula (Figure). There was no evidence of a hematoma, necrosis or a generalized allergic reaction. His vital signs were stable. We elected to observe the patient. The swelling decreased markedly during the following 48 hr and had resolved by the fifth postoperative day. There have been no reported cases in the literature of this complication with Bullard laryngoscopy and intubation. The positioning and removal of this airway device is blind, and trauma to the uvula may have occurred during this time. Less likely etiologies include trauma from blind suctioning and direct pressure from the ETT.

View larger version (100K): [in this window] [in a new window]   FIGURE Swollen hyperemic uvula.

References

1 Diaz JH. Is uvular edema a complication of endotracheal intubation? Anesth Analg 1993; 76: 1139–41.[Free Full Text]

2 Roberge RJ, Sullivan T. Topical epinephrine therapy of acute uvulitis. Am J Emerg Med 1997; 15: 331–2.[Medline]

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This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Christodoulou, C. Articles by Friesen, J. Search for Related Content PubMed PubMed Citation Articles by Christodoulou, C. Articles by Friesen, J.