Removal of an implant screwdriver with rigid bronchoscope in a patient under general anesthesia
Ebru Kaval1, Zeynep Ersoy1, Zeynep Kayhan1, Dalokay Kılıç2
1Başkent Üniversitesi Hastanesi Anesteziyoloji ve Reanimasyon Anabilimdalı Ankara
2Başkent Üniversitesi Hastanesi Göğüs Kalp Damar CerrahCerrahisi Anabilimdalı Ankara
Accidental aspiration or ingestion of a dental instrument can be a life-threating event that we come across during dental procedures. Endodontic instruments, teeth, orthodontic brackets, implant screwdrivers are some of these instruments. The instruments and components like restorative materials or implant parts become wet with saliva can also be a reason for dental accidents. Most of the cases of foreign body ingestion or aspiration are under 5 years old age or elderly patients with psychological or neurological dysfunction. Sedation, alcohol, mental retardation, unconsciousness can also increase the risk of accidental aspiration or ingestion. Dental prostheses covering the palate may reduce tactile sensation and may also increase the risk. This report presents the anesthetic management of a patient during removal of an implant screwdriver with rigid bronchoscope after an accidental aspiration. A 70 year old man was admitted to our hospital with accidental aspiration of a screwdriver implant during dental implants rehabilitation. Aspiration was confirmed with chest radiography in posteroanterior and lateral projections. A computerized tomography scan was performed to locate the aspirated material and it was shown in right main bronchus. Vital signs of the patient were all in normal ranges and the patient had no clinical symptoms of aspiration. Total intravenous anesthesia with short acting agents were used with volatile anesthetics.Oxygen and volatile agents given to the patient via a side port of rigid bronchoscope. The material was removed with rigid bronchoscope without any complications and patient was discharged from hospital 24 hours later. CO2 retantion and an acute desaturation are the common complications for RB and adequate ventilation should be ensured. Patients should be observed after the process for the bronchoscopy connected complications.
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