Safety implications of the Boyle-Davis mouth gag and tracheal tube position in tonsillectomy

8Citations
Citations of this article
36Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

Background. The risk of death after tonsillectomy is extremely small, and is mostly caused by the direct or indirect effects of haemorrhage or anaesthetic complications. These complications include aspiration, accidental dislodgement of the tracheal tube (TT), and pneumothorax or pneumomediastinum. The Boyle-Davis mouth gag (BDG) is a device used to visualize the oropharynx and stabilize the TT during tonsillectomy. We postulate that a deployed BDG may influence the position of the TT, and potentially result in silent aspiration, accidental extubation, and unilateral pulmonary ventilation. This has not, to our knowledge, been evaluated before. The aim of this prospective, pilot study was to evaluate the displacement of the TT upon opening and closing the BDG, in an objective manner. Methods. Patients undergoing tonsillectomy with/without adenoidectomy at a regional department underwent flexible bronchoscopy to evaluate the changes in position of the TT tip with the BDG in an open and closed position, relative to the position of the carina. Results. Twenty-three patients were enrolled into the study. Deploying the BDG resulted in TT displacement in 96 of patients. The mean displacement was 9.5 mm (range-10 to +27 mm). Conclusions. We believe that this study raises concerns not previously highlighted, on how manipulating a BDG may influence the TT position. It may serve to explain additional mechanisms of potentially fatal anaesthetic complications such as TT dislodgement, unilateral ventilation, and pneumothorax, particularly in paediatric patients, after tonsillectomy. © The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

References Powered by Scopus

Complications of tonsillectomy and adenoidectomy

308Citations
N/AReaders
Get full text

Complications of endotracheal intubation and mechanical ventilation in infants and children

179Citations
N/AReaders
Get full text

Displacement of the endotracheal tube caused by change of head position in pediatric anesthesia: Evaluation by fiberoptic bronchoscopy

83Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Ambulatory anesthesia aspects for tonsillectomy and abrasion in children

10Citations
N/AReaders
Get full text

Evaluation of the effect of Boyle-Davis mouth gag on intracranial pressure in patients undergoing adenotonsillectomy by using ultrasonographic optic nerve sheath diameter measurement

6Citations
N/AReaders
Get full text

Massive pneumomediastinum with subcutaneous emphysema after elective adenotonsillectomy in children: Involvement of the Boyle-Davis mouth gag

6Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Fennessy, B. G., O’Connor, R., Cronin, M., Fenton, J. E., & Hughes, J. P. (2010). Safety implications of the Boyle-Davis mouth gag and tracheal tube position in tonsillectomy. British Journal of Anaesthesia, 105(6), 863–866. https://doi.org/10.1093/bja/aeq264

Readers' Seniority

Tooltip

Professor / Associate Prof. 10

48%

PhD / Post grad / Masters / Doc 8

38%

Researcher 2

10%

Lecturer / Post doc 1

5%

Readers' Discipline

Tooltip

Medicine and Dentistry 15

58%

Philosophy 6

23%

Nursing and Health Professions 4

15%

Agricultural and Biological Sciences 1

4%

Save time finding and organizing research with Mendeley

Sign up for free