Figure 3: The cuff of an internal diameter 7.0 mm endotracheal tube was modified during deflation to make a frill-like fold (arrows) at the proximal end.

Mentions: Repair of the intrathoracic trachea was completed, but checking the tracheal laceration in the proximal part remained. We decided to conduct a fiberoptic bronchoscopic evaluation. In the left lateral decubitus position, we extubated an endobronchial double-lumen tube and inserted a laryngeal mask airway (LMA-CLASSIC™, Intavent Orthofix, UK) to use it as a pathway for the fiberoptic bronchoscopic evaluation. The evaluation revealed that the repair was complete, as the proximal part of the tracheal laceration was located up to 5 cm below the vocal cord. After the surgery, intubation was done using an ID 7.0 mm single-lumen tube with a deflated cuff (Fig. 3) with the patient in a supine position and then fixed the tube so that the cuff was located in the area right under the vocal cord, where it was not damaged. By carrying out a leakage test, we checked that there was no air leak around the cuff at an inspiratory pressure of 20 cm H2O. The patient was then transferred to the intensive care unit (ICU). In the ICU, tidal volume of the patient was kept at around 300 ml with an inspiratory pressure of 10 cm H2O by synchronized intermittent mandatory ventilation (SIMV). Extubation was performed in the ICU about 14 hours after the surgery.

Kim J, Lim T, Bahk JH - Korean J Anesthesiol (2011)

Bottom Line: To check the possibility of laceration of the proximal trachea, the double lumen tube was changed to an LMA for use as a conduit for fiberoptic bronchoscopic evaluation in the lateral position.A plain endotracheal tube with the cuff modified and collapsed was re-intubated after evaluation.And then she was transferred to SICU.

Affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

Abstract: A 76-year-old, 148-cm woman was scheduled for right upper lobectomy. A 32 Fr left-sided double lumen tube was placed using a conventional technique. Despite several attempts under fiberoptic bronchoscope-guidance, we could not locate the double lumen tube properly. We thus decided to proceed with the bronchial tube in the right mainstem bronchus. During surgery, 8-cm-long laceration was noted on the posterolateral side of the trachea. To check the possibility of laceration of the proximal trachea, the double lumen tube was changed to an LMA for use as a conduit for fiberoptic bronchoscopic evaluation in the lateral position. A plain endotracheal tube with the cuff modified and collapsed was re-intubated after evaluation. And then she was transferred to SICU.