Palatal obturator: Perioperative concerns
Identifieur interne : 001F98 ( Pmc/Corpus ); précédent : 001F97; suivant : 001F99Palatal obturator: Perioperative concerns
Auteurs : Vanita Ahuja ; Sunita Kazal ; Shradha SinhaSource :
- Indian Journal of Anaesthesia [ 0019-5049 ] ; 2014.
Url:
DOI: 10.4103/0019-5049.126840
PubMed: 24700914
PubMed Central: 3968668
Links to Exploration step
PMC:3968668Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Palatal obturator: Perioperative concerns</title><author><name sortKey="Ahuja, Vanita" sort="Ahuja, Vanita" uniqKey="Ahuja V" first="Vanita" last="Ahuja">Vanita Ahuja</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India</nlm:aff></affiliation></author><author><name sortKey="Kazal, Sunita" sort="Kazal, Sunita" uniqKey="Kazal S" first="Sunita" last="Kazal">Sunita Kazal</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India</nlm:aff></affiliation></author><author><name sortKey="Sinha, Shradha" sort="Sinha, Shradha" uniqKey="Sinha S" first="Shradha" last="Sinha">Shradha Sinha</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24700914</idno><idno type="pmc">3968668</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968668</idno><idno type="RBID">PMC:3968668</idno><idno type="doi">10.4103/0019-5049.126840</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001F98</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001F98</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Palatal obturator: Perioperative concerns</title><author><name sortKey="Ahuja, Vanita" sort="Ahuja, Vanita" uniqKey="Ahuja V" first="Vanita" last="Ahuja">Vanita Ahuja</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India</nlm:aff></affiliation></author><author><name sortKey="Kazal, Sunita" sort="Kazal, Sunita" uniqKey="Kazal S" first="Sunita" last="Kazal">Sunita Kazal</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India</nlm:aff></affiliation></author><author><name sortKey="Sinha, Shradha" sort="Sinha, Shradha" uniqKey="Sinha S" first="Shradha" last="Sinha">Shradha Sinha</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India</nlm:aff></affiliation></author></analytic><series><title level="j">Indian Journal of Anaesthesia</title><idno type="ISSN">0019-5049</idno><idno type="eISSN">0976-2817</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Keyf, F" uniqKey="Keyf F">F Keyf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hou, Yz" uniqKey="Hou Y">YZ Hou</name></author><author><name sortKey="Huang, Z" uniqKey="Huang Z">Z Huang</name></author><author><name sortKey="Ye, Hq" uniqKey="Ye H">HQ Ye</name></author><author><name sortKey="Zhou, Ys" uniqKey="Zhou Y">YS Zhou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bagis, B" uniqKey="Bagis B">B Bagis</name></author><author><name sortKey="Aydo An, E" uniqKey="Aydo An E">E Aydoğan</name></author><author><name sortKey="Hasanreiso Lu, U" uniqKey="Hasanreiso Lu U">U Hasanreisoğlu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roumanas, Ed" uniqKey="Roumanas E">ED Roumanas</name></author><author><name sortKey="Nishimura, Rd" uniqKey="Nishimura R">RD Nishimura</name></author><author><name sortKey="Davis, Bk" uniqKey="Davis B">BK Davis</name></author><author><name sortKey="Beumer, J" uniqKey="Beumer J">J Beumer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Apfelbaum, Jl" uniqKey="Apfelbaum J">JL Apfelbaum</name></author><author><name sortKey="Hagberg, Ca" uniqKey="Hagberg C">CA Hagberg</name></author><author><name sortKey="Caplan, Ra" uniqKey="Caplan R">RA Caplan</name></author><author><name sortKey="Blitt, Cd" uniqKey="Blitt C">CD Blitt</name></author><author><name sortKey="Connis, Rt" uniqKey="Connis R">RT Connis</name></author><author><name sortKey="Nickinovich, Dg" uniqKey="Nickinovich D">DG Nickinovich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Apfelbaum, Jl" uniqKey="Apfelbaum J">JL Apfelbaum</name></author><author><name sortKey="Connis, Rt" uniqKey="Connis R">RT Connis</name></author><author><name sortKey="Nickinovich, Dg" uniqKey="Nickinovich D">DG Nickinovich</name></author><author><name sortKey="Pasternak, Lr" uniqKey="Pasternak L">LR Pasternak</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Anaesth</journal-id><journal-id journal-id-type="iso-abbrev">Indian J Anaesth</journal-id><journal-id journal-id-type="publisher-id">IJA</journal-id><journal-title-group><journal-title>Indian Journal of Anaesthesia</journal-title></journal-title-group><issn pub-type="ppub">0019-5049</issn><issn pub-type="epub">0976-2817</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24700914</article-id><article-id pub-id-type="pmc">3968668</article-id><article-id pub-id-type="publisher-id">IJA-58-87</article-id><article-id pub-id-type="doi">10.4103/0019-5049.126840</article-id><article-categories><subj-group subj-group-type="heading"><subject>Letters to Editor</subject></subj-group></article-categories><title-group><article-title>Palatal obturator: Perioperative concerns</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ahuja</surname><given-names>Vanita</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Kazal</surname><given-names>Sunita</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Sinha</surname><given-names>Shradha</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1">Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Vanita Ahuja, Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, India. E-mail: <email xlink:href="vanitaanupam@yahoo.co.in">vanitaanupam@yahoo.co.in</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jan-Feb</season><year>2014</year></pub-date><volume>58</volume><issue>1</issue><fpage>87</fpage><lpage>89</lpage><permissions><copyright-statement>Copyright: © Indian Journal of Anaesthesia</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions></article-meta></front><body><p>Sir,</p><p>A 46-year-old male, weighing 60 kg with diabetes mellitus type II since 10 years was scheduled for debridement of the nasal cavity under general anaesthesia (GA). Patient had undergone surgical procedure for mucormycosis under GA uneventfully one year ago. Systemic examination was unremarkable. The airway examination showed a Mallampati (MMP) class IV [<xref ref-type="fig" rid="F1">Figure 1a</xref>] with mouth opening of 3 cm, thyromental distance of 10 cm and possible anterior mandibular protrusion. Patients blood biochemistry and other routine investigations were acceptable. Patient was kept nil per oral and premedicated with anxiolytics and antacids on the night before and on the morning of surgery while morning dose of insulin was omitted. On the day of surgery blood sugar and electrolytes were within the normal range. In the operating room, a multi parameter monitor (AS5, Datex Ohmeda, Finland) was attached to the patient and after securing intravenous (IV) access, IV glycopyrrolate 0.2 mg and IV fentanyl 120 μg were given. Difficult airway cart was kept ready. GA was induced with IV propofol 120 mg and IV succinylcholine 100 mg was given after confirmation of ability to ventilate the lungs. Oral endotracheal intubation was performed with 8.0 mm cuffed endotracheal tube with Glidescope<sup>®</sup> (GVL; Verathon Inc., Bothell, WA). During intubation, the posterior end of palatal obturator was visualized. Following correct placement of endotracheal tube, the palatal obturator was removed [<xref ref-type="fig" rid="F1">Figure 1b</xref>]. Rest of the perioperative period was unremarkable.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>(a) Airway examination of patient shows a mallampati grade IV. (b) The palatal obturator after removal</p></caption><graphic xlink:href="IJA-58-87-g001"></graphic></fig><p>Palatal obturator is a prosthetic device and is indicated in patients with cleft palate, traumatic injuries and tumours of palate.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref>] Palatal obturator consists of an acrylic plate and retention clasps of orthodontic wire, which covers a fistula of the palate. It serves to restore speech, mastication, deglutition and aesthetics.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref>] Successful obturation depends on the volume of the defect, tissue retention available around the cavity and development of muscular control.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>] It must be as light as possible as its weight may act as a dislocating force.[<xref rid="ref3" ref-type="bibr">3</xref>] The palatal obturator can cause anaesthetic complications including airway obstruction, inability to pass endotracheal tube due to dislodgement of prosthesis, limitation of the space for a laryngoscope and a traumatic intubation.</p><p>According to recent practice guidelines for management of the difficult airway, video-assisted laryngoscopy can now be used as an initial approach to intubation in patients in non-emergent pathway with difficult airway.[<xref rid="ref5" ref-type="bibr">5</xref>] We administered succinylcholine considering uneventful previous anaesthetic exposure of the patient and MMP class IV being the only predictor for difficult airway and rest of the airway examination also being normal.[<xref rid="ref5" ref-type="bibr">5</xref>] The difficult airway cart with other alternative intubation devices were however kept ready.</p><p>The absence of symptoms of regurgitation of food or water, MMP class IV on airway examination and observer limitation of not able to differentiate between similar looking palatal obturator with the oral mucosa in room light; all probably contributed to the cause of missed finding in the present case. However, we did not encounter any complication during the anaesthetic procedure.</p><p>Pre-anaesthesia evaluation is considered as basic element of anaesthesia care and includes a multi-disciplinary approach including patient's medical record, history taking, physical examination and findings from medical tests and evaluations. At the same time, anaesthesiologist should consult other health-care professionals to obtain information relevant to perioperative care to avoid any catastrophe. Assessment performed during pre-anaesthetic evaluation may be used to formulate plans for intraoperative care, post-operative recovery, perioperative pain management and patient education.[<xref rid="ref6" ref-type="bibr">6</xref>]</p></body><back><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Keyf</surname><given-names>F</given-names></name></person-group><article-title>Obturator prostheses for hemimaxillectomy patients</article-title><source>J Oral Rehabil</source><year>2001</year><volume>28</volume><fpage>821</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">11580820</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hou</surname><given-names>YZ</given-names></name><name><surname>Huang</surname><given-names>Z</given-names></name><name><surname>Ye</surname><given-names>HQ</given-names></name><name><surname>Zhou</surname><given-names>YS</given-names></name></person-group><article-title>Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy: A case report</article-title><source>Int J Oral Sci</source><year>2012</year><volume>4</volume><fpage>114</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">22653550</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bagis</surname><given-names>B</given-names></name><name><surname>Aydoğan</surname><given-names>E</given-names></name><name><surname>Hasanreisoğlu</surname><given-names>U</given-names></name></person-group><article-title>Rehabilitation of a congenital palatal defect with a modified technique: A case report</article-title><source>Cases J</source><year>2008</year><volume>1</volume><fpage>39</fpage><pub-id pub-id-type="pmid">18631384</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Roumanas</surname><given-names>ED</given-names></name><name><surname>Nishimura</surname><given-names>RD</given-names></name><name><surname>Davis</surname><given-names>BK</given-names></name><name><surname>Beumer</surname><given-names>J</given-names><suffix>3rd</suffix></name></person-group><article-title>Clinical evaluation of implants retaining edentulous maxillary obturator prostheses</article-title><source>J Prosthet Dent</source><year>1997</year><volume>77</volume><fpage>184</fpage><lpage>90</lpage><pub-id pub-id-type="pmid">9051607</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Apfelbaum</surname><given-names>JL</given-names></name><name><surname>Hagberg</surname><given-names>CA</given-names></name><name><surname>Caplan</surname><given-names>RA</given-names></name><name><surname>Blitt</surname><given-names>CD</given-names></name><name><surname>Connis</surname><given-names>RT</given-names></name><name><surname>Nickinovich</surname><given-names>DG</given-names></name><etal></etal></person-group><article-title>Practice guidelines for management of the difficult airway: An updated report by the American society of anesthesiologists task force on management of the difficult airway</article-title><source>Anesthesiology</source><year>2013</year><volume>118</volume><fpage>251</fpage><lpage>70</lpage><pub-id pub-id-type="pmid">23364566</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Apfelbaum</surname><given-names>JL</given-names></name><name><surname>Connis</surname><given-names>RT</given-names></name><name><surname>Nickinovich</surname><given-names>DG</given-names></name><name><surname>Pasternak</surname><given-names>LR</given-names></name><etal></etal></person-group><collab>Committee on Standards and Practice Parameters, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation</collab><article-title>Practice advisory for preanesthesia evaluation: An updated report by the American society of anesthesiologists task force on preanesthesia evaluation</article-title><source>Anesthesiology</source><year>2012</year><volume>116</volume><fpage>522</fpage><lpage>38</lpage><pub-id pub-id-type="pmid">22273990</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Santé/explor/EdenteV2/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001F98 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 001F98 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Santé
|area= EdenteV2
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:3968668
|texte= Palatal obturator: Perioperative concerns
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:24700914" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a EdenteV2
| This area was generated with Dilib version V0.6.32. |  |