A & A case reports
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The reported adverse effects of perioperative transesophageal echocardiography (TEE) are mostly associated with the insertion and manipulation of the TEE probe. Recent data suggest that blind probe insertion may be associated with greater morbidity than reported previously. ⋯ Herein, we present a novel insertion technique using a soft-tipped esophageal bougie as a guide for blind TEE probe insertion in a patient undergoing cardiac surgery. The potential advantages and related safety issues are discussed.
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A 37-year-old woman underwent transsphenoidal surgery for recurrent pituitary adenoma. Postoperatively, she had a prolonged intensive care unit stay and repeated tracheal intubations because of inadequate airway reflexes. On postoperative day 25, she had difficulty maintaining her airway, and the nursing staff attempted orotracheal suctioning, which failed. ⋯ Computed tomography showed diffuse pneumocephalus and a new parenchymal hemorrhage. The only temporally related event was use of a nasotracheal catheter. This case suggests that nasotracheal suctioning may not be safe in patients who have recently undergone transsphenoidal procedures.