Nasal Bleed Aspirated Postextubation. A Scary Experience

Introduction: Pulmonary aspiration of gastric content is a risk associated with administration of anesthesia, which is common during induction of anesthesia in patients with a full stomach. Maxillofacial injuries lead to bleeding, which is often swallowed by the patient and therefore they cannot be considered nil orally. Proper precaution during induction and extubation has to be maintained to prevent aspiration. Case Report: A 28 year old male 80 kg with Body Mass Index (BMI) 35 had a road traffic accident and sustained nasal bone fracture and was planned for an emergent exploration and repair by the ENT surgeons. Induction of anesthesia was done uneventfully after rapid sequence induction; airway secured, but after extubation patient aspirated the nasal bleed regurgitated from the stomach. The patient was reintubated and managed in the intensive care unit and discharged subsequently with no sequel. Conclusion: Oro-Gastric Tube (OGT) insertion is key in managing patients with airway bleeds and apart from conventional techniques other methods can be used to insert OGT and extubation should always be considered equally risky for aspiration of gastric content as at the time of intubation. However, with all the measures taken there is still the risk associated which demands a skilled anesthesia provider for managing the pulmonary aspiration acutely which can reduce the morbidity and mortality in these scenarios.