[Undetachable connection between a reinforced endotracheal tube and L connector]

We anesthesiologists sometimes encounter a situation where we difficulty detaching an L connector from an endotracheal tube. However, to our knowledge, there is no paper wich describes complete inability of detaching the connector from the tube. A 33-year-old female patient was scheduled for jaw joint arthroplasty and manipulation of synarthrophysis after the previous intermaxillary fixation. After midazolam and fentanyl administration, the trachea was intubated with a reinforced endotracheal tube (Mallinckrodt Inc., St. Louis, USA) through the right nostril with the aid of a bronchofiberscope. When we tried to move the anesthesia machine, we could not detach the L connector from the endotracheal tube by any means. Furthermore, because a slip-joint is glued to a reinforced endotracheal tube, it was impossible to separate them. The patient had locklaw, and therefore to avoid reintubation, we scraped off the surface of the L connector, and the connector was successfully detached. Although slip-joints of tracheal tubes and L connectors are standardized with JIS and ISO, their connection is not necessarity good due to the difference of makers and/or a tolerance of products. We think that Tracheostomy Wedge (Portex Inc., New Hampshire, USA) is useful for detaching the cconnection.