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Unexpected tracheal tube cuff leak due to tracheal deformity in a patient with bronchiectasis

Unexpected tracheal tube cuff leak due to tracheal deformity in a patient with bronchiectasis A 62‐year‐old man with a history of bronchiectasis was listed for a total nephroureterectomy for urological malignancy. General anaesthesia was induced and facemask ventilation was performed with ease. A 7.5‐mm internal diameter tracheal tube (Parker Flex Tip, P3 Medical, Bristol, United Kingdom) was easily advanced into the trachea, to a depth of 22 cm. A large cuff leak was noted despite gradual inflation of the cuff with 15 ml of air. Mechanical ventilation was ineffective. The tracheal tube was exchanged for tubes of 8.0 mm then 9.0 mm internal diameter but a large cuff leak persisted. A supraglottic airway device provided sufficient seal for the provision of mechanical ventilation whilst discussion ensued on how to proceed.Computed tomography imaging of the patient's thorax demonstrated an elliptical upper trachea and triangular mid‐trachea (Fig. 1). The tracheal tube was repositioned so that the cuff was inflated just below the glottis, which abolished the cuff leak. Other solutions could have included ongoing use of the supraglottic airway device, insertion of a throat pack, or use of a bronchoscope to examine the airway and optimise tube positioning.1FigureComputed tomography images of the thorax and corresponding tracheal schematic: (a) upper trachea; (b) mid trachea; (c) distal trachea.The causes of tracheal tube http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Unexpected tracheal tube cuff leak due to tracheal deformity in a patient with bronchiectasis

Tamura, Y.; Saiki, E.; Hayashi, Y.
Anaesthesia Reports , Volume 10 (2) – Jul 1, 2022
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Publisher
Wiley
Copyright
2022 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12196
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Abstract

A 62‐year‐old man with a history of bronchiectasis was listed for a total nephroureterectomy for urological malignancy. General anaesthesia was induced and facemask ventilation was performed with ease. A 7.5‐mm internal diameter tracheal tube (Parker Flex Tip, P3 Medical, Bristol, United Kingdom) was easily advanced into the trachea, to a depth of 22 cm. A large cuff leak was noted despite gradual inflation of the cuff with 15 ml of air. Mechanical ventilation was ineffective. The tracheal tube was exchanged for tubes of 8.0 mm then 9.0 mm internal diameter but a large cuff leak persisted. A supraglottic airway device provided sufficient seal for the provision of mechanical ventilation whilst discussion ensued on how to proceed.Computed tomography imaging of the patient's thorax demonstrated an elliptical upper trachea and triangular mid‐trachea (Fig. 1). The tracheal tube was repositioned so that the cuff was inflated just below the glottis, which abolished the cuff leak. Other solutions could have included ongoing use of the supraglottic airway device, insertion of a throat pack, or use of a bronchoscope to examine the airway and optimise tube positioning.1FigureComputed tomography images of the thorax and corresponding tracheal schematic: (a) upper trachea; (b) mid trachea; (c) distal trachea.The causes of tracheal tube

Journal

Anaesthesia Reports – Wiley

Published: Jul 1, 2022

Keywords: airway assessment; cuff leakage: tracheal deformity; tracheal intubation

References

  • Endotracheal tube cuff leaks: causes, consequences, and management
    El‐Orbany, M; Salem, RM
  • Anesthesia with the ProSeal laryngeal mask airway for a patient with Mounier‐Kuhn syndrome
    Imashuku, Y; Kitagawa, H; Fukushima, Y; Aoi, R