There are various hazards of endotracheal 1 and endobronchial intubation but, fortunately, they occur infrequently. The complications can arise during intubation, during maintenance with endotracheal anaesthesia or extubation. This paper deals briefly with the problem of mechanical trauma to the respiratory tree occurring during the operation.
CASE REPORTS J aged 54 years, a road worker, was found to have a 2cm opacity in the right upper lobe during a routine X-ray following a chest infection.A thoracotomy was undertaken on 20 May 1971. Endobronchial anaesthesia was established using a left-sided Robertshaw tube after bronchoscopy had revealed no abnormality. The tube passed easily under thiopentone and suxamethonium anaesthesia and, after inflating the cuffs, each lung could be ventilated separately. The bronchial cuff required 5ml of air.The right chest was opened, the right lung was deflated and the left lung ventilated.There was a considerable leak past the endobronchial cuff. It was, therefore, emptied and the tube was pushed forward a short distance. The cuff was slowly reinflated with 7ml of air. There was still a leak, but this was accepted and compensated for by ventilating on a Brompton Manley ventilator with a minute volume of 10 litres and a tidal volume setting of 700ml. The expiratory tidal volume measured by a Wright Respirometer in the ventilator outlet was 400-500ml.The lung was found to be bilobed. The upper lobe was removed with hilar glands.Histology showed subsequently that there was a poorly differentiated epidermoid carcinoma with no glandular involvement. 'Frothing' of the mediastinal tissues, as is seen in mediastinal emphysema, was first noticed when the first stitches were being inserted into the bronchus. The mediastinum was moving well with respiration but the inspiratory leak was increasing. It was assumed that a left-sided pneumothorax had occurred from a ruptured emphysematous bulla, but exploration of the left pleural cavity via the inferior, posterior mediastinurn did not reveal a pneumothorax.The mediastinal emphysema continued to increase and the patient's general condition was deteriorating. The mediastinum was then explored at the point of maximum emphysema and a tear was found in the membranous part of the left main bronchus extending from the tracheal carina to the left lower lobe bronchus.
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