Laryngeal injury during intubation

Q: Risk factors for laryngeal injury during intubation include all of the following except? 

A) Traumatic intubation 
B) Using a myorelaxant 
C) Large Endo-Tracheal-Tube (ETT)
D) Aspiration 
E) Presence of a nasogastric tube


Answer: B

There are several risk factors for laryngeal injury during and after the procedure is done. Use of neuro-muscular blockade (NMB) during intubation decreases the risk of laryngeal injury. Other risk factors include female gender, older age, traumatic intubation, wider ETT, aspiration during or afterward the procedure, unplanned extubation, and presence of a nasogastric tube. Also, underlying co-morbidities like diabetes, hypertension, decreased cardiac ejection fraction, renal insufficiency, and malnutrition are risk factors. 

Important to note that obesity is not included in this list as higher BMI may be associated with difficult intubation but not the laryngeal injury unless an operation turned it into a traumatic work.

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

3. Kikura M, Suzuki K, Itagaki T, et al. Age and comorbidity as risk factors for vocal cord paralysis associated with tracheal intubation. Br J Anaesth 2007; 98:524. 

4.  Dargin JM, Emlet LL, Guyette FX. The effect of body mass index on intubation success rates and complications during emergency airway management. Intern Emerg Med 2013; 8:75.