laryngeal injury

Q: All of the following are risk factors for laryngeal injury via Endotracheal tube (ETT) except? 

A) Prolonged intubation 
B) Traumatic intubation 
C) Using a muscle relaxant during intubation
D) Unplanned extubation 
E) Presence of a nasogastric tube


Answer: C

The objective of above question is to highlight the importance of proper skills and techniques to be used during intubation. It is not uncommon to see that medical staff skip the use of a muscle relaxant during intubation for various reasons including unresponsiveness of a patient, fear of increasing the risk of myopathy, hyperkalemia, difficult intubation or desaturation.

Muscle relaxants should be employed during intubation unless absolutely contraindicated or risk is too high.


References:

1. Tadié JM, Behm E, Lecuyer L, et al. Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study. Intensive Care Med 2010; 36:991. 

2. Santos PM, Afrassiabi A, Weymuller EA Jr. Risk factors associated with prolonged intubation and laryngeal injury. Otolaryngol Head Neck Surg 1994; 111:453. 

3. Colton House J, Noordzij JP, Murgia B, Langmore S. Laryngeal injury from prolonged intubation: a prospective analysis of contributing factors. Laryngoscope 2011; 121:596.

4. Friedman M, Baim H, Shelton V, et al. Laryngeal injuries secondary to nasogastric tubes. Ann Otol Rhinol Laryngol 1981; 90:469.