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Raynaud Case Summary

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Glossal pulse oximetry for anaesthetic management of patient with Raynaud’s phenomenon.

Raynaud’s phenomenon, is a disorder of the microvasculature due to vasoconstriction of the digital arteries, arterioles, and cutaneous arteriovenous shunts, affecting the fingers and toes but can present on nose, ears and nipples. Continuous pulse oximetry, a standard basic anaesthesia monitoring as per the American Society of Anaesthesiology (ASA) recommendation, could be challenging for these patients posted for surgery under anaesthesia. We discuss a case of Raynaud’s phenomenon where glossal pulse oximetry was used intraoperatively.
A 65-year-old female, case of adenocarcinoma of lung was posted for radiofrequency ablation under general anaesthesia.
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Pulse oximetry reading could not be recorded by standard finger probe. Ear lobe pulse oximeter showed room air saturation of 95% with weak tracing and poor plethysmograph. Patient was administered general anaesthesia, using injection fentanyl 100 µg, injection propofol 100 mg. The airway was secured using laryngeal mask airway supreme No. 3. No improvement was seen in the ear lobe tracing post anaesthesia. The probe was then placed on lingual surface of tongue, as shown in the picture. Anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane, the case was continued using glossal pulse oximetry monitoring which was switched back to ear lobe prior to removal of supraglottic device. Rest of recovery was…show more content…
High cost of the Nasal Alar SpO2 sensor, £20.62 per unit may deter its use in resource limited settings. Alternatively, invasive arterial line could be inserted to measure arterial blood gases pre-induction, post intubation and following extubation, which could give a better information in such patients posted for major surgeries.
In this era of newer gadgets, we hope that reporting of this case will help in familiarizing the newer generation of anaesthesiologists to this old lost technique. In conclusion, glossal oximetry is a valuable method of intraoperative pulse oximetry in patient with Raynaud’s phenomenon.
References:
1. Coté CJ, Daniels AL, Connolly M, Szyfelbein SK, Wickens CD Tongue oximetry in children with extensive thermal injury: comparison with peripheral oximetry, Can J Anaesth, 1992; 39: 454–7.
2.Hickerson W, Morrell M, Cicala RS. Glossal pulse oximetry. Anesth Analg 1989;
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