This case involves a young man who suffered an injury to his lower back in the course of his employment as a roofer. The man was advised to undergo lumbar decompression surgery as treatment, for which he would receive general anesthesia. When the patient was put under anesthesia, doctors placed an endotracheal tube to maintain the patient’s airway during the procedure. However, when the patient began his recovery from the surgery, he discovered that injuries to his vocal chords caused during his intubation prevented him from speaking. Despite undergoing extensive treatment, the patient continued to have severe difficulty speaking. It was alleged that the patient was injured by the negligent insertion of his endotracheal tube by the anesthesiologist.
Question(s) For Expert Witness
- 1. How often do you intubate patients for surgery?
- 2. What precautions are taken not to injure the vocal cords If it is a difficult intubation?
Expert Witness Response E-110402
I often intubate patients within the OR and also in emergency situations, which can vary by location – emergency rooms, ICU’s and medical floors. I also serve as an ICU physician and intubate routinely there. On average, I am personally involved in intubating about 15-20 patients per week. For surgery specifically, I intubate the great majority of my patients. Precautions taken first include an up to date history and physical and discussion with the patient – which also includes a personally reviewed airway and neck movement exam, as well as a review of dental status. I also conduct a review of previous anesthetics, if any, and review of those records. Precautions that are taken to avoid vcoal cord injury include the direct visualization of vocal cords with or without the use of video laryngoscopy. If difficult intubation is anticipated, then doctors should consider awake fiberoptic versus asleep intubation. Other precautions used are smaller sized endotracheal tubes, the use of laryngeal mask airway if appropriate, or the use of regional anesthesia.