Dental injury in anaesthesia: a tertiary hospital's experience.

BACKGROUND: Dental injury is a common perioperative complication, but there are no country specific data available, especially with the use of supraglottic airway devices (SAD). The aims of our study are to report the incidence, risk factors, and local practices in the management of perioperative dental injuries in Singapore. METHODS: We analyzed data from the departmental database from 2011 to 2014, noting the anticipated difficulty of airway instrumentation, intubation grade, pre-existing dental risk factors, location of dental trauma discovery, position of teeth injured and presence of dental referral. The risk factors for dental trauma were then identified using logistic regression (between 51 dental trauma patients and 55,107 patients without dental trauma). RESULTS: The rate of dental injury was 0.092% for general anaesthesia cases. The most significant patient risk factor is the presence of pre-existing dental risk factors (OR 12.55). Anaesthetic risk factors include McGrath MAC usage (OR 2.51) and a Cormack and Lehane grade of 3 or more (OR 7.25). Most of the dental injuries were discovered in the operating theatre. 7 (13.7%) patients had SAD inserted and only 23 (45.1%) cases were referred to dental services. CONCLUSION: Videolaryngoscopy with the McGrath MAC is associated with an increased likelihood of dental injury. This could be either because videolarygoscopes were used when increased risk of dental trauma was anticipated, or due to incorrect technique of laryngoscopy. Future studies should be done to establish the causality. The management of dental injuries could be improved with development of departmental guidelines.

Non-diabetic euglycaemic ketoacidosis and rapid weight loss in a post-traumatic surgical patient: is the outré preventable?

To highlight the implications of the metabolic stress response and the role of anaesthesia in attenuating its deleterious effects, we present this extremely rare case of non-diabetic euglycaemic ketoacidosis with rapid weight loss in a post-traumatic surgical patient. Ketoacidosis is the accumulation of ketone bodies in blood and is generally associated with relative or absolute insulin deficiency secondary to diabetes mellitus, sodium-glucose cotransporter 2 inhibitors and extensive fasting. The stress of systemic disease, trauma or surgery in such predisposed patients could precipitate ketoacidosis. Our patient developed high anion gap metabolic acidosis intraoperatively due to ketosis, a potentially life-threatening complication, without any predisposing factors as a result of metabolic stress of major trauma and surgery. Aiding the interpretation, he lost 15 kg weight perioperatively, suggesting his body was in a hypercatabolic state. This report emphasises the value of anaesthetic techniques to prevent such rare complications.

Cricoid pressure: ritual or effective measure?

Cricoid pressure has been long used by clinicians to reduce the risk of aspiration during tracheal intubation. Historically, it is defined by Sellick as temporary occlusion of the upper end of the oesophagus by backward pressure of the cricoid cartilage against the bodies of the cervical vertebrae. The clinical relevance of cricoid pressure has been questioned despite its regular use in clinical practice. In this review, we address some of the controversies related to the use of cricoid pressure.