[Airway obstruction in a patient using a cuff button-like silicone cannula for tracheal stoma]

We described a case of postoperative airway obstruction in a patient using a cuff button-like silicone cannula for tracheal stoma. A 59-year-old woman with rheumatoid arthritis, was admitted to the hospital for total knee arthroplasty. She had been managed by a long-term tracheostomy for rheumatic cricoarytenoid arthritis. Preoperative examination revealed no cardiopulmonary compromise. The surgery was performed under combined spinal-epidural anesthesia without any respiratory problems. Fifteen hours after surgery, she complained of dyspnea. Her oxygen saturation by pulse oximeter was 22-28%. We immediately removed the silicone cannula and inserted a tracheostomy tube. Her condition was dramatically improved next few minutes after the insertion. There were no dyskinesia and neurological disorders. We considered that airway obstruction occurred with the inadequate position of the cuff button-like silicone cannula, attached to the posterior wall of the trachea, sputum augmenting the obstruction.