Airway obstruction with cuffed flexometallic tracheal tubes

The occurrence of an airway obstruction with a cuffed flexometallic tracheal tube is reported. The cause of the obstruction is attributed to internal herniation of the distal extremity of the tube secondary to diffusion of anaesthetic gases into the tracheal tube cuff and subsequently between the two layers of the distal extremity of the tube. Methods to avoid overdistension of the cuff volume are described.