Dissection of the wired endotracheal tube's lumen during general anesthesia: a case report

Abstract

Objective: The aim of this study is to report a case of a clinically significant obstruction during mechanical ventilation caused by the dissection of the wired endotracheal tube's lumen during general anesthesia in a pediatric patient. Case report: A 12-years old patient undergoing general anesthesia for open appendectomy was intubated with a wired endotracheal tube and difficult removal of the guide. After starting the mechanical ventilation, there was increased expiratory fraction of CO 2 and need for increased inspiratory pressure. Chance of complications with higher incidences were raised and treated unsuccessfully. Finally, during patient reintubation, the dissection of the endotracheal tube lumen was observed, and ventilation was restored to normal. Conclusion: Anesthesia involves numerous possible complications. Suspicion and constant vigilance are essential for early diagnosis and treatment of any threat to the individual integrity. This case is relevant for emphasizing a possible very rare complication related to airway, which can quickly cause hypoxia and irreversible damage. Thus, this case contributes to the detection of this complication more frequently. Relato: Paciente de 12 anos submetido à anestesia geral para apendicectomia aberta foi intubado com tubo endotraqueal aramado e retirada de guia do tubo difícil. Após iniciar a ventilação mecânica houve aumento da fração expiratória de CO 2 e necessidade de aumento da pressão inspiratória. Hipóteses de complicações com maiores incidências foram aventadas e tratadas sem sucesso. Finalmente, ao reintubar o doente, foi verificada dissecção do lúmen do tubo endotraqueal e a ventilação foi restaurada à normalidade. Conclusão: O ato anestésico envolve inúmeras possíveis complicações. A suspeição e a vigilância constantes são essenciais para diagnosticar e tratar precocemente qualquer ameaça à integridade do indivíduo. O presente caso é relevante por enfatizar uma possível complicação muito incomum relacionada às vias aéreas capaz de causar hipóxia e danos irreversíveis rapidamente. Dessa forma, o caso contribui para que essa intercorrência seja detectada com maior frequência. PALAVRAS-CHAVE

Airway obstruction by a folding metal rod within a Reinforced Oral tracheal Tube: Case Report

“…9 Postoperatively in patients intubated by oral route, the wired endotracheal tube should be replaced by the conventional polyvinyl chloride endotracheal tube to prevent partial or total airway obstruction that can be caused by bites. 10 The deformity of the ROT with a reduction in its internal caliber, generates obstruction of ventilation with a sudden increase in inspiratory pressures with expiratory fraction of CO2, 11 and complications such as hypoxia, negative pressure pulmonary edema, increased intracranial pressure and increased blood pressure. 5 In this present study, the reduction in tidal volume and hypoxemia were relevant.…”

Airway obstruction by dissection of the inner layer of a reinforced endotracheal tube in a patient with Ludwig's angina: A case report

“…Most of them were related to repetitive resterilization with N 2 O [ 2 3 ] or even without N 2 O [ 4 5 ]. In some cases, the dissection was attributed to faulty manufacturing [ 6 7 8 9 ], while one case claimed that it was due to difficulty with stylet removal [ 10 ]. During production of the tube, a liquid polyvinyl chloride layer coats a rod.…”