Difficult tracheal extubation

Abstract

We describe a case of nasotracheal tube fixation with a screw. A second case is described in which a broken drill bit was found to impinge on the wall but not penetrate into the lumen of a nasotracheal tube. Possible sequelae of this complication include airway leak, aspiration, tube obstruction, and trauma from attempts at forceful extubation. We recommend the routine intraoperative testing for tracheal tube movement and routine fibreoptic bronchoscopy through the tube when blind surgical procedures occur in the vicinity of a tracheal tube.

Résumé

On communique un cas de fixation du tube nasotrachéal par une vis. Un deuxième cas est décrit ou la meche brisée d’une perceuse s’est appuyée sur la paroi du tube nasotrachéal sans le percer. Les complications possibles sont les suivantes: perte d’air du tube nasotrachial, aspiration bronchique, obstruction du tube nasotrachéal et une lésion secondaire a une extubation traumatique. Nous recommendons que la mobilité du tube trachéal soit examinée de routine au cours de l’opération et qu’une bronchoscopie flexible soit faite de routine par le tube trachéal quand une procedure chirurgicale n’est pas faite sous vision directe dans la proximité d’un tube trachéal.

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Correspondence to David H. Johnson.

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Lang, S., Johnson, D.H., Lanigan, D.T. et al. Difficult tracheal extubation. Can J Anaesth 36, 340–342 (1989). https://doi.org/10.1007/BF03010778

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Key words

  • anaesthesia techniques: bronchoscopy, extubation
  • intubation, tracheal: complications, extubation
  • surgery: oral
  • syndromes: Beckwith Wiedeman