Repeated inadvertent endobronchial intubation during laparoscopy

Abstract

Inadvertent endobronchial intubation occurred twice during laparoscopic surgery, with two different causes. Radiography was the only means of definitive diagnosis.

Inability to detect unintentional endobronchial intubation by conventional signs and its detection by the radiologist during fluoroscopy for cerebral aneurysm coiling

“…Second, head and neck flexion during positioning for the procedure could have moved the tip of the ETT into the right main bronchus. The second explanation is more plausible and has been reported [2,11]. Because a diagnosis of endobronchial intubation appeared to have been excluded, in our differential diagnosis, we considered the possibility of desaturation due to secretions, bronchospasm, and underventilation (atelectasis) of the lung bases due to obesity and underlying parenchymal disease.…”

“…In summary, this report serves to reinforce the prevailing evidence that auscultation of bilateral equal breath sounds alone does not always exclude the risk of endobronchial intubation; moreover, changes in etco 2 or a marked increase in peak airway pressures may not be observed in all cases. Ultimately, radiographic confirmation of tube position remains among the definitive means of diagnosis [11], and we would advocate its use in clinical circumstances in which fluoroscopy is available and other methods of diagnosis are either equivocal or unavailable.…”

Cuffed versus uncuffed pediatric endotracheal tubes

“…The cephalad movement of the carina relative to the tube in those situations has led to endobronchial intubation in adults 4 and children. For this reason, if a cuffed tube is used during laparoscopy, we believe that the "ideal" position of the cuff being distal to the cricoid cartilage 5 is unrealistic; instead, it should be passed just distal to the vocal cords.…”

Tracheal tube tip displacement during laparoscopy in children*

“…Displacement of the tip of the tracheal tube in adults during laparoscopy is a well known and widely studied problem [1][2][3][4][5][6][7][8][9][10]. Components leading to displacement include increased intraperitoneal pressure due to the capnoperitoneum and the head-down tilt (Trendelenburg) position, both of which are needed to improve the surgical view during laparoscopy.…”