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VOLUME 21 , ISSUE 10 ( 2017 ) > List of Articles


Blowing Bubbles Helps Intubation

David Howe

Keywords : Difficult airway, rapid sequence induction, suxamethonium

Citation Information : Howe D. Blowing Bubbles Helps Intubation. Indian J Crit Care Med 2017; 21 (10):710-711.

DOI: 10.4103/ijccm.IJCCM_73_17

License: CC BY-ND 3.0

Published Online: 01-01-2019

Copyright Statement:  Copyright © 2017; The Author(s).


Rocuronium is commonly used in preference to suxamethonium for rapid sequence induction in the Intensive Care Unit (ICU). We describe a patient who suffered significant neck trauma following a suicide attempt. On initial presentation to accident and emergency, he was an easy intubation with a Grade 1 view obtained at laryngoscopy. After surgery to repair his neck laceration, he was extubated and discharged from ICU. He later developed a severe aspiration pneumonia and required reintubation. After induction and paralysis with suxamethonium, the best view at laryngoscopy was a Grade 3 despite the use of different laryngoscopes. As the muscle paralysis wore off the patient began breathing. This produced bubbles in the back of the patient's pharynx which directed the clinician to the laryngeal inlet to allow successful intubation. In this case, the short duration of action of suxamethonium significantly aided intubation due to the return of spontaneous breathing by the patient.

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  1. Tran DT, Newton EK, Mount VA, Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 2015;(1):CD002788.
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