Use of the Cook airway exchange catheter in "bridging" the potentially difficult extubation: a case report

The Cook airway exchange catheter (CAEC) is a long, flexible, hollow tube designed to facilitate the exchange of an in situ endotracheal tube. The primary use of the CAEC had been as a tube exchanger in the critical care setting. The unique characteristics of this device led us to use and report the use of the CAEC in the anesthetic management of a morbidly obese patient with significant tracheal deviation secondary to an enlarged thyroid gland. The potential strategies that we considered in this case were (1) extubating the patient in a deep plane of anesthesia; (2) extubating conventionally, with the patient awake; and (3) extubating the patient awake, with a "bridge" to full extubation. After carefully weighing the options, we decided to use the CAEC as a tool that would allow us, if the patient did well, to go forth to full extubation, or, if the patient's condition deteriorated, to return to reintubation, or even oxygen insufflation, which would create a "bridge" to extubation.