Defective endotracheal tube: Undetected by routine inspection

Successful management of a case of delayed post-operative recovery under general anesthesia due to endotracheal tube defect and malfunction in a case of massive abdominal teratoma in 2-month-old infant

“…Delayed post-operative recovery due to endotracheal tube defect and malfunction and not visible from the outside [2,5]. Shamse et al [3] reported difficulty in inserting the stylet inside the tube which happened due to narrowing of the tube connector making ventilation difficult and occlusion of tube lumen, similar to our case.…”

“…For a safe airway and ventilation, anesthesia machine and equipment used to provide airway should be checked thoroughly. Improper checking causes a high incidence of life-threatening complications during anesthetic procedures [3][4][5].…”

“…Airway obstruction should be suspected if airway and breathing bag pressures increase with ventilation difficulty before enough tidal volume is generated. After satisfactory system check, ETT defects such as herniation, air leakage [5,6], kinking of the cuff, intraluminal plastic film, or obstruction by meniscus and obliteration of ETT connector are known manufacturing defects and can produce difficulty in ventilation [1,2,6,[8][9][10]. It becomes mandatory on part of the anesthesiologist to immediately change faulty equipment if any manufacturing defect of the ETT is suspected [2,3].…”

Compromised ventilation in an infant caused by a defective connector of endotracheal tube

“…[ 2 ] Literature shows an increased incidence of airway obstruction with the use of resterilized ETT, deformed T connector, and the presence of plastic meniscus at the patient end of the connector. [ 3 4 ] Adoption of a systematic approach while remembering the simple mnemonic DOPE (displacement of the tube, obstruction, pneumothorax, and equipment failure) can help in preventing morbidity by early detection. [ 5 ] In our case, the hospital purchasing committee was notified, and strict quality control from the manufacturers was ensured.…”

Endotracheal tube connector defect causing airway obstruction in a child

“…If successful intubation is followed by difficulty in ventilating the patient, certain conditions such as acute bronchospasm, tension pneumothorax, endobronchial mass lesion, poor pulmonary compliance, kinking and defects of endotracheal tube (ETT) and anaesthesia delivery system malfunction should be ruled out. [ 1 2 ] Manufacturing defects of the ETT may remain unnoticed during routine inspection[ 3 4 ] as occurred in this case and that led into partial obstruction of airway. [ 5 ]…”