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- Title
Successful management of endotracheal tube cuff rupture in case of difficult airway scenario for oropharyngeal surgery.
- Authors
Lalwani, Parin; Venkateswaran, Vineeta
- Abstract
Endotracheal tube (ETT) cuff leaks can be encountered in the operating room with variable consequences ranging from a mere annoying bubbling sound to life-threatening respiratory compromise requiring immediate intervention. This scenario becomes more challenging if there is a difficult airway with limited mouth opening and oromaxillofacial surgery where nasal intubation is required with a north pole tube. ETT replacement can expose the patient to airway loss or life-threatening hypoxemia during the ETT exchange. There are no recommended guidelines on how to deal with an ETT cuff leak and no published step-by-step safe management strategy. With the lack of defined protocols and guidelines to manage intraoperative cuff leaks, the presence of mind and ability to make critical decisions by the anesthesiologist cannot be overemphasized. We present a case report of a 40-year-old patient weighing 70 kg diagnosed with carcinoma retromolar trigone posted for wide local excision and posterior segmental mandibulectomy. On airway examination, he had a limited mouth opening of <1 cm, with both nostrils of equal and adequate size. As mask ventilation was not difficult after induction of general anesthesia, we did fiberoptic-guided right nasal intubation with North Pole tube. We were unable to inflate the cuff of ETT and there was a significant leak. Here, we discuss how we exchanged the ETT in this difficult airway scenario.
- Subjects
NECK surgery; MANDIBLE surgery; MEDICAL equipment reliability; PHYSICAL diagnosis; FIBER optics; TRACHEOTOMY; PROPOFOL; SUCCINYLCHOLINE; TRACHEAL diseases; ENDOTRACHEAL tubes; MOUTH tumors; GENERAL anesthesia; SURGICAL flaps; SKIN grafting; MEDICAL device removal; INTUBATION; ALVEOLECTOMY; GLYCOPYRROLATE; PHENYLPROPANOLAMINE; FENTANYL; ARTIFICIAL respiration; OXYGEN therapy; ROUTINE diagnostic tests; OROPHARYNX; TRACHEA intubation; BRONCHOSCOPY
- Publication
MAMC Journal of Medical Sciences, 2023, Vol 9, Issue 2, p139
- ISSN
2394-7438
- Publication type
Article
- DOI
10.4103/mamcjms.mamcjms_42_23