Damage to endotracheal cuff inflation tube by harmonic scalpel in tonsillectomy leading to compromised airway

Authors

  • Asfar Azimee Shija Hospitals and Research Institute, Meitei Langol, Lamphelpat, Imphal, Manipur 795004
  • Dinesh Singh Thounaojam Shija Hospitals and Research Institute, Meitei Langol, Lamphelpat, Imphal, Manipur 795004

DOI:

https://doi.org/10.3126/jsan.v3i1.14596

Keywords:

airway management, anaesthesia, complications, endotracheal tube

Abstract

Use of harmonic scalpel has increased in the recent past for different surgical procedures. We report a case of damage to an endotracheal tube inflation line in a 47 year old female patient who underwent elective tonsillectomy due to harmonic scalpel. Pre-anaesthetic evaluation of the patient revealed no abnormalities. The patient’s trachea was intubated via nasal route with a cuffed north facing Ring, Adair and Elwyn tube of 7.0 mm internal diameter. The cuff was inflated after confirmation of tracheal placement of tube and pharyngeal packing was done. After 30 minutes of surgery, the bellows of the ventilator were collapsing. Suspecting a leak an attempt was made to inflate the cuff, which revealed high resistance in inflation tube. Surgeon was immediately asked to stop the surgery. Check laryngoscopy revealed damage to cuff inflation tube which was sealed by harmonic scalpel in semi-inflated condition. Anticipating that the tracheal extubation in that inflated position would result in vocal cord trauma, a 23 gauge spinal needle attached to 5ml syringe was introduced under direct laryngoscopic guidance. The cuff was punctured and air aspirated so as to deflate the cuff. The tube was taken out and was replaced. The surgery continued for next one hour, was uneventful and trachea extubated at completion.

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Author Biographies

Asfar Azimee, Shija Hospitals and Research Institute, Meitei Langol, Lamphelpat, Imphal, Manipur 795004

DA DNB, Attending consultant, Department of Anaesthesiology and Critical Care

Dinesh Singh Thounaojam, Shija Hospitals and Research Institute, Meitei Langol, Lamphelpat, Imphal, Manipur 795004

MD, Senior Consultant, Department of Anaesthesiology & Critical Care

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Published

2016-03-20

How to Cite

Azimee, A., & Thounaojam, D. S. (2016). Damage to endotracheal cuff inflation tube by harmonic scalpel in tonsillectomy leading to compromised airway. Journal of Society of Anesthesiologists of Nepal, 3(1), 41–43. https://doi.org/10.3126/jsan.v3i1.14596

Issue

Section

Case Reports