Had a patient roll into my room for a pacemaker, I scanned the assessment, filled out by our MDA; dental part said: intact. Eyeball test revealed teeth that looked ok enough, about average for a 67 year old. Induction and placement of LMA without incident. At the end of surgery LMA comes out easy and I place an oral airway (pt had OSA) as I had been taught. Upon rolling out to recovery, the patient bites down on the airway and I can hear as his two front teeth snap. Once in recovery, he relaxes and I pull the airway out and try to fish out his teeth but can't find them (Xray revealed 2 crown in the stomach). What I do see are the rotten roots that were anchoring his two crowns.

This really upset me and as I reflect on it, I'm not sure if I would do anything different. I could leave the LMA in but who's to say it wouldn't have happened on the LMA? The CRNAs said they wouldn't have done anything differently; the MDA said he avoids airways if at all possible and doesn't routinely put them in (then again, he doesn't routinely do cases). Leading into this- I've seen an intubated young person bite down on an airway so hard upon wake up that I was certain he was going to shatter his teeth. Now I'm real nervous about using airways. On the flip side, I don't want my intubated patients to bite the ETT going thru stage 2 and end up with NPPE.

What have you found that works best in your practice? Words of wisdom?