learning from the experience of others

lable at ScienceDirect

Trends in Anaesthesia and Critical Care xxx (2014) 1

Contents lists avai

Trends in Anaesthesia and Critical Care

journal homepage: www.elsevier .com/locate/ tacc

COMMENTARY

Learning from the experience of others

Gareth B. Kitchen*

North Western Deanery, 26 Parklands Way, Poynton, Cheshire SK12 1AL, UK

Keyword:Hypoglossal nerve

Hypoglossal nerve injury as a consequence of anaesthesia is arare event. It has been published in the literature a number oftimes.1e3

As anaesthetists we are in a privileged position, takingcompletely well individuals and subjecting them to anaesthesiaand the associated risks. We take away a patient’s auto-regulationand their ability to protect themselves; consequently we assumeresponsibility for their wellbeing whilst they are anaesthetised.

Complications such as hypoglossal nerve palsy are so rare thatan individual anaesthetist may not encounter it during their career.However, as a laryngeal mask is a device that most of us will insertthousands of times, we have a responsibility to learn the lessons ofothers and adapt aspects of individual practice to ensure the risk toour patients is as low as possible.

It is therefore important that we learn lessons such as thatdescribed by Kapoor et al. to reduce this risk. High cuff pressuresare a highlighted causative factor that is easily remedied by theregular measurement of cuff pressure, suggested at 30 min in-tervals. This is especially important when using nitrous oxide asthis may increase the cuff pressure further and therefore increasethe risk on hypoglossal nerve injury.4

It is also our responsibility to recognise the potential compli-cations of anaesthesia in our post-operative visit and treat themaccordingly. In this case report by Kapoor et al.,5 morbidity wasavoided by making a timely diagnosis and administration of ste-roids. A rapid referral to a specialist and initiation of relevant in-vestigations is also our responsibility. In this case that meantreferral to the neurologist, enabling more sinister causes of the

DOI of original article: http://dx.doi.org/10.1016/j.tacc.2014.03.003.* Tel.: þ44 07977280019.

E-mail address: gkitchen@me.com.

http://dx.doi.org/10.1016/j.tacc.2014.04.0112210-8440/� 2014 Elsevier Ltd. All rights reserved.

Please cite this article in press as: Kitchen GB, Learning from the experiedx.doi.org/10.1016/j.tacc.2014.04.011

patients’ symptoms to be excluded and the suspected diagnosisconfirmed, we also have the ability to organise and expedite in-vestigations required by the specialists.

One significant take home message is the importance of thepost-operative visit. In the environment of long lists the necessityof increased productivity and efficiency it may be tempting to gohome at the end of a long day without visiting our patients.However, this visit is invaluable to our patients and their nursingstaff, providing a safety net enabling the diagnosis and manage-ment of complications and alterations in any medications that maybe required, for example analgesics. It is also the greatest resourcewe have for feedback on our own practice and alterations weshould make to improve the experience for future patients.

Conflict of interests

The author has no conflict of interests to declare.

References

1. Nagai K, Sakuramoto C, Goto F. Unilateral hypoglossal nerve paralysis followingthe use of the laryngeal mask airway. Anesthesia 1994;49:603e4.

2. Brain AJ, Howard D. Lingual nerve injury associated with laryngeal mask use.Anaesthesia 1998;53:713e4.

3. King C, Street MK. Twelfth cranial nerve paralysis following use of a laryngealmask airway 1994;49:786e7.

4. Lumb AB, Wrigley MW. The effect of nitrous oxide on laryngeal mask cuffpressure. Anesthesia 1992;47:320.

5. Kapoor, Badhwar S, Velli N. Hypoglossal nerve palsy following the use oflaryngeal mask airway. TACC; 2014.

nce of others, Trends in Anaesthesia and Critical Care (2014), http://