A Case of Decreased Swallowing Function Caused by Insertion of a Cricothyrotomy Kit

Abstract

Introduction:　This paper reports a case of decreased deglutition function due to the insertion of a cricothyrotomy kit．

Case:　An 83-year-old male，hospitalized for examination of arrhythmia．

Course:　Coronary aorta bypass grafting was performed on Day 8，and the patient started to take porridge on Day 10．However，ventricular tachycardia occurred frequently on Day 11 and disturbance of consciousness and dyspnea developed．Although the kit was inserted for use of an expectorant，his cough became frequent immediately after insertion and therefore saburra was sucked by a tracheal cannula．Functional decline was recognized in a deglutition evaluation by a speech-language-hearing therapist on Day 12．Furthermore，the patient was diagnosed with aspiration pneumonitis by chest X-ray and blood sampling and was forbidden to eat．Video-fluoroscopic (VF) examination performed on Day 18 revealed a decrease in larynx elevation in the pharynx period and test food remaining in the vallecula and piriform recess．The test food was not swallowed by one swallowing motion which was therefore repeated plural times，and part of the food entered the larynx．After VF，it was suspected that detention of the kit affected the swallowing function and therefore the kit was removed．VF on Day 23 showed that anterosuperior movement of the larynx was performed earlier and remaining food was reduced: it became possible to take the test food by one swallowing．Aspiration was not recognized after restarting porridge meal，his overall status improved and the patient was discharged on Day 31．

Discussion:　The distance of laryngeal elevation was shorter by 0.41 vertebral body and the delay time of laryngeal elevation was longer by 0.06 second while the cricothyrotomy kit was inserted than after removing the kit，in which state laryngeal insertion could be easily performed．When a tracheotomy that incises the second and third tracheal cartilage by small incision is performed，decrease of swallowing function due to limitation of hyoid and larynx elevation has been pointed out．This limitation of elevation presumably also occurred even with the kit inserted．Cricothyrotomy has been considered to be less invasive，allowing for rapid securing of the airway in comparison with tracheostomy，with a localized decline in ADL after insertion．However，insertion of the kit in cricothyrotomy may cause severe swallowing dysfunction even though it is a relatively simple procedure．The kit should be removed immediately when swallowing dysfunction is exacerbated．A strict judgment on its adaptation is needed when inserting the kit．