Airway Disaster After Routine Appendectomy

Editor’s note: This week’s case is for paying subscribers.

A 48 year old man presented to the ED with abdominal pain and was diagnosed with appendicitis.

He was booked for a laparoscopic appendectomy.

Medical history included tobacco use and well controlled asthma.

He was 5’9” and 185lbs.

After being consented for GA he was brought to the OR.

He arrived in the OR at 2:48pm and an RSI was performed.

The patient was intubated by a CRNA via direct laryngoscopy.

Surgery ended at 4:00pm.

At 4:14pm the patient was extubated. He immediately began snoring and then desaturating.

Oxygen was delivered by facemask without improvement. The CRNA attempted to aid ventilation.

She then placed a nasal trumpet which did not help.

The anesthesiologist came to assist.

Realizing they were not successfully ventilating the patient, intubation was attempted.

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