Abstract
We thank Dr Woodforth for his letter to the editor and the additional references regarding anaesthetic suction and the potential for causing uvular trauma. We did publish a case in the Autumn 2020 issue of the Australian and New Zealand College of Anaesthetists (ANZCA) Bulletin
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as noted by Dr Woodforth. We subsequently interrogated the web-based anaesthetic incident reporting system (webAIRS) database and found a further 12 cases, making 13 in total. These 13 cases were the basis for our findings and discussion. It should be noted that in our introduction we stated: Ischaemia is thought to be a result of mechanical compression of the blood supply of the uvula against the hard palate by an oropharyngeal device (e.g. endotracheal tubes (ETTs), laryngeal masks, upper gastrointestinal endoscopy, transoesophageal echocardiogram, aggressive oropharyngeal suction).
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We also stated: It has been suggested that prevention of uvular necrosis might be possible by placing any oropharyngeal devices away from the midline, avoiding blind suctioning and lowering the power of suction devices.
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In our case series, at least one case was extensively suctioned due to oral secretions and possible aspiration. While this may have been the cause of uvular injury, it was not possible to confirm this retrospectively. In the 13 cases in our series, we did not have any reports that confirmed causation, but we did have details of the diagnosis, follow-up and management. We therefore concentrated on these aspects rather than speculated on the causation, which was not described in detail in any of the reports.
However, we agree that suction devices should be used cautiously, with low suction pressure and under direct vision where possible, and we included this information in our introduction. We are grateful for the additional information regarding oropharyngeal suction as one of the several possible modes of uvular trauma.
