Dear doctorchou2-ga,
Thank you for your very interesting question on self-intubation. In
my clinical experience, I had never heard of such a thing being
performed, so my curiosity was particularly peaked by your
proposition. In searching the Ovid PubMed database, I was initially
unable to find any report of self-intubation.
Google, however, came through. A search on ?self intubation? yielded
a single published record, which I could then find via PubMed. Below
is this report, from the journal Critical Care Medicine. This was
published as a letter to the editor in November, 2002. As the
authors? say, they were also unable to find any previous report of
self-intubation, and performed the procedure to better understand what
patient?s experience during conscious intubation.
A second case of self-intubation was merely mentioned in the
conference proceedings of the 2004 meeting of the Difficult Airway
Society, held in Leicester, England. The presentation had the
following title:
Two-scope Fibreoptic Self-Intubation
S Scott, A Kapi
Here?s a link to the meeting agenda:
http://www.das.uk.com/leicester2004.html
and a link to the society itself:
http://www.das.uk.com/
A confounder in the search was that self-intubation, as you may know,
often refers to placing one?s own nasogastric tube (a tube through the
nose into the stomach) for feeding purposes.
Perhaps also of interest to you (I presume you are in some way
associated with anesthesiology) as a bit of bizarre medical trivia ?
There appears to be a small number of individuals who take part in
self-intubation (using a Laryngeal Mask Airway (LMA) I presume) as
part of a restraint-oriented sexual fetish. Extreme indeed. Here are
some (non-graphic) photos:
http://www.timberwoof.com/masterwoof/medical/LMA23/pages/20040125_083050_jpg.htm
http://www.timberwoof.com/masterwoof/medical/LMA23/pages/20040125_082525_eyes_JPG.htm
Obviously, these are not ?published? accounts, so I will not delve any
further into this shady world.
I think, in summary, that Dr. Sekiyama, Hiroshi from the University of
Tokyo Department of Anesthesiology would stake the most valid claim as
the last individual who intubated himself and published an account.
I hope this answer was helpful. Please feel free to ask for clarification.
-welte-ga
__________________________________________________________
Critical Care Medicine
Volume 30(11) November 2002 p 2611
Clinician?s Feeling and Patients? Sensations
[Letters To The Editor]
Sekiyama, Hiroshi MD; Sakamoto, Tetsuya MD, PhD; Hanaoka, Kazuo MD, PhD
Department of Anesthesiology, University of Tokyo, Tokyo, Japan
To the Editor:
Conscious intubation is usually performed for patient safety under
topical anesthesia in patients who are at high risk for unconscious
intubation for myriad reasons. Since a Scottish surgeon, William
Macewan, undertook the first use of oral intubation for an anesthetic
in 1878 (1), innumerable clinicians have performed intubation and some
clinicians may even have been intubated awake. To our knowledge,
however, self-intubation has never been reported. Therefore, I
intubated myself to better appreciate the patient?s sensations that
accompany conscious intubation, as well as to correlate the feeling of
inserting the endotracheal tube with the sensations felt within the
larynx.
I performed this procedure, while observing myself in a mirror, with a
laryngoscope and an 8.0-mm ID Endotrol tracheal tube. Lidocaine spray
was applied topically to the pharynx and larynx for anesthesia, and no
opioids or sedatives were used. Because self-applied direct
laryngoscopy through a mirror did not allow visualization of the
glottis, this procedure was accomplished in a blind fashion. The
endotracheal tube was advanced past the vocal cords during
inspiration, and objective confirmation of proper placement was
attained via the self-inflating bulb (2). Two minutes later, I
performed self-extubation. Instructors from the Department of Critical
Care Medicine were present at this trial and verified my
self-intubation. A slight sore throat persisted for 1 hr after the
procedure, and by the next day, I was engaged in my anesthesia
responsibilities in the operating room without sequelae.
From self-intubation, we learned several things. 1) Besides the
sensation of self-applied direct laryngoscopy, the most noxious
sensation resulted from the tube pushing both vocal cords bilaterally
and drawing them down, widening the glottis. 2) Topical anesthesia
using lidocaine spray could block tactile sensation but not deep
sensation. 3) While advancing the tube, the stronger resistance that
was felt by my hand correlated with more severe discomfort in my
larynx or trachea. Both the resistance and the discomfort were less
during inspiration than during expiration. 4) Once the tube was
secured in place, almost no discomfort persisted, except for the
inability to vocalize. 5) The trial was accompanied by a vague sense
of fear, however.
We believe that this is the first report of self-intubation and that
our findings include insights for relieving the patient?s distress.
Self-intubation made us appreciate the crudeness of our technique and
improve it. In conducting this trial, we can better sympathize with a
patient?s fear, anxiety, and stress.
Hiroshi Sekiyama, MD
Tetsuya Sakamoto, MD, PhD
Kazuo Hanaoka, MD, PhD
REFERENCES
1. Macewan W: Clinical observations on the introduction of tracheal
tubes by the mouth instead of performing tracheotomy or laryngotomy.
BMJ 1880; 2: 122?124.
2. Kasper CL, Deem S: The self-inflating bulb to detect esophageal
intubation during emergency airway management. Anesthesiology 1998;
88: 898?902 |
,
0 Comments
)