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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.
Journal of Clinical Anesthesia
|September 2, 2008
Summary
A silicone endotracheal tube (ETT) cuff herniated during anesthesia due to nitrous oxide diffusion. This complication, linked to electromyographic (EMG) monitoring, caused ventilation failure, highlighting material risks.
Area of Science:
- Anesthesiology
- Biomaterials Science
- Medical Device Engineering
Background:
- Electromyographic (EMG) endotracheal tubes (ETTs) are used for laryngeal nerve monitoring during surgery.
- Silicone-based ETT cuffs are a component of some specialized EMG ETTs.
- Anesthesia involves the use of various anesthetic gases, including nitrous oxide.
Observation:
- A complication occurred with a silicone-based EMG ETT during anesthesia.
- Sudden inability to ventilate was observed 30 minutes after anesthesia initiation.
- The event was attributed to herniation of the ETT cuff.
Findings:
- Nitrous oxide likely diffused into the silicone-based ETT cuff, causing it to expand.
- In vitro testing demonstrated a significant intracuff pressure increase (approx. 50 mmHg) in silicone cuffs with nitrous oxide.
- This pressure increase was substantially higher than in standard polyvinyl chloride-based ETTs (approx. 10 mmHg).
Implications:
- Silicone-based EMG ETT cuffs may pose a risk of herniation and ventilation compromise when used with nitrous oxide.
- Anesthesiologists should be aware of potential material-gas interactions with specialized ETTs.
- Further research into ETT material compatibility with anesthetic gases is warranted to ensure patient safety.
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