Intraoperative airway obstruction caused by dissection of the internal wall of a reinforced endotracheal tube - A case report -

Abstract

Endotracheal intubation is generally performed to access and protect the airway, and it has become a routine procedure in general anesthesia. However, intubation is not a risk-free procedure. Furthermore, obstruction of an endotracheal tube (ETT) is a potentially life-threatening event [1]. Intraoperative ventilation failure may occur because of various causes such as patients' respiratory diseases, types of operation and patient's position during the operation, and malfunctioning of the anesthesia machine or equipment.ETT obstruction can result from kinking or biting of the tube, foreign body aspiration, or thick or inspissated secretions in the lumen. Rarely, ETT problems, such as herniation of the cuff, dissection, or detachment of the internal wall, can cause obstruction [1]. We report an unusual case of ETT obstruction caused by dissection of the internal wall of a reinforced tube. CASE REPoRTA 67-year-old woman (164 cm, 68 kg) who was previously healthy, except for being a hepatitis C virus carrier, was Endotracheal intubation is the gold standard for airway management in general anesthesia. However, airway patency is not guaranteed by keeping the endotracheal tube (ETT) in place. Sometimes, the ETT itself may become a cause of airway obstruction; there are some reports on airway obstruction related to reinforced tube malfunction. We report a rare case with an obstruction of reinforced endotracheal tubes caused by dissection of the internal wall. Recognition of the possibility of airway obstruction due to a rare cause and monitoring patients vigilantly during anesthesia is very important for patient safety.Key Words: Airway obstruction, Dissection, Endotracheal tube. Anesth Pain Med 2017;12:394-397 https://doi.org/10.17085/apm.2017.12.4.394 pISSN 1975-5171ㆍeISSN 2383 Case Report 394 mixture of 1.5 L to 1.5 L of O 2 and N 2 O. Five minutes after intubation, the patient was stable with ETCO 2 35 mmHg, peak inspiratory pressure (PIP) 17-18 cmH 2 O, and SpO 2 99%. After the patient was placed in a prone position, there was a mild increase in PIP to 20 cmH 2 O. However, lung sounds were normal. Thirty minutes after the patient's position changed, the PIP was gradually increased to 24 cmH 2 O and the tidal volume was decreased to 350 ml. The lung sounds were heard equally in both lungs without wheezing. Ventolin was administered for bronchodilation, and rocuronium (10 mg) was injected intravenously for muscle relaxation; however, they produced almost no effect. There was no kinking or biting of the tube in the mouth, but the suction catheter could not pass beyond approximately 10 cm from the tube connector. We found that the pressure-volume loop and flowvolume loop showed obstructive patterns compared to the initial ones (Fig. 1A). In addition, ETCO 2 and PIP increased to 48 mmHg and 30 cmH 2 O (preset pressure limit), respectively; the SpO 2 level was maintained at 99%. The fiberoptic bronchoscope was inserted, but we could not advance it past 10 cm; we found that the swelling of the internal wall of the tube...