Partial Obstruction of an Armored Endotracheal Tube during a Carotid Endarterectomy due to Tracheal Deviation in a Pnemonectomized Patient.

Bai,  Sun Joon; Kim,  Ki Jun; Kim,  Jong Hoon; Kim,  Kun Ho; Park,  Wyun Kon

doi:2001.41.1.105

Clinical Research Article

Korean Journal of Anesthesiology 2001;41(1):105-109.
DOI: https://doi.org/10.4097/kjae.2001.41.1.105

Partial Obstruction of an Armored Endotracheal Tube during a Carotid Endarterectomy due to Tracheal Deviation in a Pnemonectomized Patient.

Sun Joon Bai, Ki Jun Kim, Jong Hoon Kim, Kun Ho Kim, Wyun Kon Park

Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Endotracheal tube obstruction during anesthesia can have many causes. Hyperinflation of the remaining lung after a pneumonectomy can severely displace the trachea, and attachment of an endotracheal tube tip to the wall of a deviated trachea may also cause severe airway obstruction. The right lung of the patient was removed 3 years ago due to lung cancer. Compensatory hyperinflation of the left lung and severe right-sided tracheal deviation was seen on a chest X-ray. An armored endotracheal tube without Murphy's eye was used. Two hours after beginning the operation, peak airway pressure and PETCO2 began to increase gradually. A wheezing-like sound was heard. Bronchospasm was suspected, but signs of a spasm were not relieved by medications. The signs completely disappeared after pulling the tube 2 cm proximal. The position of the tube should be confirmed by fiberoptic bronchoscopy or chest X-ray after intubation when the trachea is deviated.

Key Words: Complications: airway; endotracheal tube obstruction; Equipment: tubes, endotracheal