urge

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How do you approach an intubation in a pt with poor dental condition? Regular laryngoscopy, fob, intubating lma, light wand, glidescope....?
 

jetproppilot

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How do you approach an intubation in a pt with poor dental condition? Regular laryngoscopy, fob, intubating lma, light wand, glidescope....?
Do it with the technique that deems you the most comfortable, as thats what'll give you the best result.

I inform every pt with bad dentition beforehand that theres a chance something will be dislodged, and thats just the way it is.
 

Apollyon

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A CRNA at Duke told me a funny story: a real mountain man was in the OR for a procedure. He had one incisor just sticking out, and loose - she pulled it out easily, and easily tubed the guy. After surgery, this fellow, whose mouth hadn't seen a dentist in forever, when she told him about the tooth, said, "Why didn't you take the rest of them out??"
 

coprolalia

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I tell those patients that their teeth suck because they haven't seen a dentist in the past 25 years, and I'm not going to charge them extra for the tooth extraction I'll shortly be performing.

-copro
 

jwk

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A CRNA at Duke told me a funny story: a real mountain man was in the OR for a procedure. He had one incisor just sticking out, and loose - she pulled it out easily, and easily tubed the guy. After surgery, this fellow, whose mouth hadn't seen a dentist in forever, when she told him about the tooth, said, "Why didn't you take the rest of them out??"
Actually, I find that kinda stupid, not funny. I would have been more impressed if s/he placed the tube without pulling the tooth.
 

Fastrach

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On a related note, gotta love the kiddos with the loose teeth. Had a 12yo boy the other day with 9 (nine) loose teeth per his report. Told him he may well lose a couple during his case, and he was fine with it. Tube went in smoothly, got case started, surgeon wants an NG so I put it down. NG felt like it was getting hung up a little as it went down, so I DL'd again to make sure it wasn't curled up.... and I see a free tooth sitting in his posterior pharynx. Magill forceps in, tooth out, saved it for the tooth fairy, explaining to kiddo & mom afterwards that we did the best we could but these things happen, and they were just fine with it. Incredibly, the next day a fellow resident tells me a story that starts with "Did you hear about this kid who died after aspirating a tooth?" I just about **** my pants wondering if it was my pt from the day before, but it was at another hospital. Certainly made me grateful I had taken a second peek in this kids mouth before extubating him!