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Updated: Jul 2, 2026

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Inability to ventilate while using a silicone-based endotracheal tube
Stephen J Gleich1, Wayne T Nicholson1, Travis M Jacobs1
1Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Abstract:
We present a complication associated with herniation of a specially designed silicone-based endotracheal tube (ETT) cuff used for laryngeal nerve monitoring (electromyographic [EMG] ETT). Lung ventilation in our patient was initially unimpeded. However, 30 minutes after initiation of anesthesia with desflurane and nitrous oxide, there was a sudden inability to ventilate due to the herniation of the ETT cuff presumably caused by diffusion of nitrous oxide into the silicone-based cuff. In vitro testing has shown that the increase in intracuff pressure during ventilation with nitrous oxide in the silicone-based EMG ETT is much greater (approximately 50 mmHg) than that in the polyvinyl chloride-based ETT (approximately 10 mmHg) routinely used in our department.
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