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LETTER TO THE EDITOR
Year : 2021  |  Volume : 5  |  Issue : 4  |  Page : 288-289

U–Turn of suction catheter within i-gel during elective surgery: An unusual presentation


Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India

Date of Submission26-Jul-2021
Date of Decision20-Sep-2021
Date of Acceptance05-Oct-2021
Date of Web Publication24-Nov-2021

Correspondence Address:
Dr. Vijay Adabala
Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Rishikesh 249201, Uttarakhand.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjoa.BJOA_83_21

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How to cite this article:
Banerjee A, Adabala V, Dhar M. U–Turn of suction catheter within i-gel during elective surgery: An unusual presentation. Bali J Anaesthesiol 2021;5:288-9

How to cite this URL:
Banerjee A, Adabala V, Dhar M. U–Turn of suction catheter within i-gel during elective surgery: An unusual presentation. Bali J Anaesthesiol [serial online] 2021 [cited 2021 Nov 28];5:288-9. Available from: https://www.bjoaonline.com/text.asp?2021/5/4/288/330959



Dear Editor,

A 36-year-old male patient with proximal humerus fracture and rotator cuff injury was posted for an open reduction and internal fixation with cuff repair. He was induced and airway management was done with the supraglottic device i-gel (size 4). A 10F plain suction catheter (Oro Cath TM: La-med Healthcare Pvt. Ltd) was passed freely without any resistance through the gastric port. At the time of fixation of the i-gel the tip of the suction catheter was noticed through the transparent part of the connector end [Figure 1]. The catheter was withdrawn and repositioned but it appeared again near the connector end. The case was allowed to proceed as ventilation was adequate without any leak. Airway pressures were also within acceptable range. Prior to extubation the suction catheter was gradually pulled out with continuous suctioning to remove the supraglottic secretions.
Figure 1: A looped suction catheter tip in the airway channel of i-gel

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The incidence of looped suction catheters in the i-gel was very less.[1],[2] Self-knotting of suction catheter distal to the i-gel has been reported. Impaction of the suction catheter in the endotracheal tube has also been reported in literature.[3] Common etiology for all these instances appears to be the use of suction catheters of lesser size than recommended for that i-gel size or repeated attempts of insertion. The type of material of catheters is also a factor. In the present case we used a 10F suction cath in a size 4 i-gel although a 12F catheter might have been more appropriate.

In such cases gastric decompression or suction of gastric content may become difficult while using the i-gel. Though in the present case, the distal tip of the catheter was clearly visible from outside but in other instances it may not be visible. So confirmation of the position of the suction tube tip in the stomach by conventional auscultation and gastric content aspiration is always recommended.

This particular complication can be prevented by using catheters with maximum size which can be passed through the gastric port channel, and using suction catheters which are made up of stiffer material. In case it is difficult to definitely confirm correct placement of suction catheter/naso gastric tube and if feasible to the surgery a spontaneous or pressure supported ventilation strategy may be applied to avoid excessive insufflation of the stomach. Working knowledge of such unusual occurrences is necessary to avoid unnecessary complications and adapt the ventilation technique accordingly.


  Declaration of patient consent Top


The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


  Financial support and sponsorship Top


The support for this study was provided solely from institutional and/or departmental sources.


  Conflicts of interest Top


There are no conflicts of interest.



 
  References Top

1.
Naik BN, Ganesh V, Saini V, Samra T. Looped suction catheter in an i-gel™; something to worry about or much ado about nothing? Indian J Anaesth 2019;63:420-1.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Kaur M, Kumar R. Commentary regarding “looped suction catheter in an i-gel™; something to worry about or much ado about nothing?”. Indian J Anaesth 2020;64:645-6.  Back to cited text no. 2
  [Full text]  
3.
Takrouri MS, Nafakh R, Abbas AA. Suction catheter impaction in preformed nasal endotracheal tube (PNETT) during pediatric dental anesthesia-hazard notice. Internet J Anesthesiol 2008;22:1.  Back to cited text no. 3
    


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