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[Dissection of the wired endotracheal tube's lumen during general anesthesia: a case report]
Fabricio Tavares Mendonça1, Leonardo Damasceno Martins1, Rodrigo Gazzi1
1Centro de Ensino e Treinamento do Hospital de Base do Distrito Federal, Brasília, DF, Brasil.
Insights
A rare complication during pediatric mechanical ventilation occurred when a wired endotracheal tube lumen dissected, causing airway obstruction. Early detection and vigilance are crucial for managing this rare anesthesia risk.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Airway Management
Background:
- Mechanical ventilation is a cornerstone of modern anesthesia and critical care.
- Wired endotracheal tubes are used to maintain airway patency during surgical procedures.
- Complications during airway management require prompt recognition and intervention.
Observation:
- A 12-year-old pediatric patient undergoing general anesthesia for appendectomy experienced respiratory compromise after intubation with a wired endotracheal tube.
- Increased end-tidal CO2 and elevated inspiratory pressures were noted during mechanical ventilation.
- Difficulties were encountered during initial intubation, including the removal of the guide wire.
Findings:
- The primary finding was the dissection of the wired endotracheal tube's lumen, leading to significant airway obstruction.
- This dissection was identified during reintubation after initial unsuccessful management attempts.
- Restoration of normal ventilation was achieved after replacing the dissected endotracheal tube.
Implications:
- This case highlights a rare but potentially life-threatening complication of wired endotracheal tubes during pediatric anesthesia.
- Constant vigilance and a high index of suspicion are essential for anesthesiologists to diagnose and manage such airway emergencies.
- Increased awareness of this complication can improve patient safety and outcomes in pediatric surgical settings.
Objective:
The aim of this study is to report a case of a clinically significant obstruction during mechanical ventilation caused by the dissection of the wired endotracheal tube's lumen during general anesthesia in a pediatric patient.
Case Report:
A12-years old patient undergoing general anesthesia for open appendectomy was intubated with a wired endotracheal tube and difficult removal of the guide. After starting the mechanical ventilation, there was increased expiratory fraction of CO2 and need for increased inspiratory pressure. Chance of complications with higher incidences were raised and treated unsuccessfully. Finally, during patient reintubation, the dissection of the endotracheal tube lumen was observed, and ventilation was restored to normal.
Conclusion:
Anesthesia involves numerous possible complications. Suspicion and constant vigilance are essential for early diagnosis and treatment of any threat to the individual integrity. This case is relevant for emphasizing a possible very rare complication related to airway, which can quickly cause hypoxia and irreversible damage. Thus, this case contributes to the detection of this complication more frequently.
