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   Table of Contents      
LETTER TO THE EDITOR
Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 172-173

A Potentially Devastating Unexpected Complication of Intubation


Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India

Date of Web Publication24-Oct-2017

Correspondence Address:
Sakshi Gandotra
Department of Anesthesiology and Intensive Care, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_44_17

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How to cite this article:
Wadhwa B, Gandotra S, Bansal V, Saxena KN. A Potentially Devastating Unexpected Complication of Intubation. MAMC J Med Sci 2017;3:172-3

How to cite this URL:
Wadhwa B, Gandotra S, Bansal V, Saxena KN. A Potentially Devastating Unexpected Complication of Intubation. MAMC J Med Sci [serial online] 2017 [cited 2019 Dec 8];3:172-3. Available from: http://www.mamcjms.in/text.asp?2017/3/3/172/217126

Sir,

Iatrogenic obstruction of endotracheal tubes by a foreign body is not uncommon and is well described in the literature. Such instances have also been reported following the reuse of endotracheal tubes that have undergone resterilisation.[1],[2] We would like to describe another case of the presence of an iatrogenic foreign body in endotracheal tube, which could have led to devastating complications.

An 18-year-old American society of Anesthesiologist (ASA) Grade 1 patient was scheduled to undergo bilateral temporomandibular joint arthroplasty. Awake fibreoptic intubation under topical anaesthesia was planned. After due patient preparation, a size 6.5 reinforced intubating laryngeal mask airway tube was inserted into the right nostril. While negotiating the flexible fibre-optic bronchoscope into the endotracheal tube, we were surprised to see a tuft of cotton gauge fibres inside the lumen of the tube [Figure 1]. Immediately, the endotracheal tube was removed and replaced with another. The rest of the anaesthetic procedure was completely uneventful. On closer inspection, the endotracheal tube had a small tuft of cotton gauge fibres, which were partially occluding the lumen [Figure 2] and [Figure 3].
Figure 1: Tuft of gauze fibres inside the tube

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Figure 2: Tuft of gauze fibres after removal from the ET tube. ET, endotracheal tube

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Figure 3: View through the fibre-optic bronchoscope

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Most of the ILMA tubes are reused multiple times after ethylene dioxide sterilization as a routine. Probably at the time of cleaning and sterilization of the endotracheal tube, the tuft of gauze pieces got struck in the lumen. If left undetected, this ball of gauze fibres could have resulted in either obstruction to ventilation through the endotracheal tube or could have been displaced further into the endotracheal tube by intermittent positive pressure ventilation, resulting in a foreign body in the tracheobronchial tree with serious consequences. Finding the cause of desaturation in such a case would have been next to impossible and even tracheostomy would not have been able to improve the ventilation in such a situation.

Rather than being an airway conduit, the endotracheal tube would have become the source of airway obstruction in this case.

The use of flexible fibreoptic bronchoscope was fortuitous, because it helped in the timely detection of the foreign body and prevented a potentially dangerous complication.

Various authors have reported airway obstruction due to anomalies in the internal wall of the reinforced tube as a result of repeated sterilizations and reuse, but this was an unexpected complication.

This incidence once again reiterates the need for constant vigilance, thorough inspection and checking of all equipments before use.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shlamovitz SZ, Halpern P. Delayed obstruction of endotracheal tube by aspirated foreign body. Ann Emerg Med 2004;43:630-3.  Back to cited text no. 1
    
2.
Walker BJ, Rampersad SE. Iatrogenic endotracheal tube obstruction with foam face padding. Paediatr Anesth 2009;19:544-5.  Back to cited text no. 2
[PUBMED]    
3.
Treadwell JR, Lucas S. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Evid Rep Technol Assess (Full Rep) 2013;(211):1-945.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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