J Dent Anesth Pain Med.  2017 Jun;17(2):135-138. 10.17245/jdapm.2017.17.2.135.

Airway obstruction by dissection of the inner layer of a reinforced endotracheal tube in a patient with Ludwig's angina: A case report

• Shim SM
• Park JH
• Hyun DM
• Lee HM

• KMID: 2384475
• DOI: http://doi.org/10.17245/jdapm.2017.17.2.135

Abstract

Intraoperative airway obstruction is perplexing to anesthesiologists because the patient may fall into danger rapidly. A 74-year-old woman underwent an emergency incision and drainage for a deep neck infection of dental origin. She was orally intubated with a 6. 0 mm internal diameter reinforced endotracheal tube by video laryngoscope using volatile induction and maintenance anesthesia (VIMA) with sevoflurane, fentanyl (100 µg), and succinylcholine (75 mg). During surgery, peak inspiratory pressure increased from 22 to 38 cmHâ‚‚O and plateau pressure increased from 20 to 28 cmHâ‚‚O. We maintained anesthesia because we were unable to access the airway, which was covered with surgical drapes, and tidal volume was delivered. At the end of surgery, we found a longitudinal fold inside the tube with a fiberoptic bronchoscope. The patient was reintubated with another tube and ventilation immediately improved. We recognized that the tube was obstructed due to dissection of the inner layer.

Keyword

Intubation; Bronchoscopes; Ludwig's Angina; Reinforced Endotracheal Tube

MeSH Terms

Aged
Airway Obstruction*
Anesthesia
Bronchoscopes
Drainage
Emergencies
Female
Fentanyl
Humans
Intubation
Laryngoscopes
Ludwig's Angina*
Neck
Succinylcholine
Surgical Drapes
Tidal Volume
Ventilation
Fentanyl
Succinylcholine

Figure

• 

  Fig. 1 Fiberoptic bronchoscopic view of the inside of the endotracheal tube. A longitudinal fold is seen inside the tube.

• 

  Fig. 2 Video laryngoscopic view for reintubation. A new endotracheal tube was prepared at the bedside for entrance of vocal cord.

• 

  Fig. 3 Cut image of the dissected tube. The inner layer was detached from the outer layer and coil.

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