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A difficult extubation: Endotracheal tube ensnarement by a Kirschner wire.

Davila VR, Schwab C, Papadimos TJ, Casabianca AB - Int J Crit Illn Inj Sci (2015 Apr-Jun)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, USA.

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After induction of general anesthesia, the patient was nasally intubated with a 7.0-cuffed endotracheal tube via the right naris... Prior to extubation, the patient was suctioned and the cuff deflated, but on withdrawal resistance was immediately met and the endotracheal tube could not be removed... Lateral and A-P radiographs were then obtained, in which a right-sided K wire appeared to impinge on the endotracheal tube [Figures 1 and 2]... Much is written about difficult intubation but little is written about difficult extubation... Previous case reports of resistance to attempted endotracheal tube removal fall into three main categories: (1) Physical impingement, (2) cuff malfunction, or (3) direct result of the surgical procedure... A popular practice is to snap the pilot bulb and valve off the pilot tube to deflate the cuff... This stretching maneuver actually occludes the pilot tube preventing cuff deflation... Finally, an endotracheal tube can become incorporated into the surgical field or compromised by the surgical procedure itself, especially during oral-maxillofacial surgery... In one report, the endotracheal tube was mistakenly incised and on removal the slit opened and subsequently caught on the hard palate preventing its removal... Ultimately, when dealing with an endotracheal tube that is difficult to remove, vigilance, sensibility, and caution are of paramount importance.

No MeSH data available.


Lateral view of skull. White arrow indicates K-wire that has inadvertently secured the endotracheal tube. Black arrow indicates edge of endotracheal tube. Rectangle indicates cervical spine
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Figure 2: Lateral view of skull. White arrow indicates K-wire that has inadvertently secured the endotracheal tube. Black arrow indicates edge of endotracheal tube. Rectangle indicates cervical spine

Mentions: Lateral and A-P radiographs were then obtained, in which a right-sided K wire appeared to impinge on the endotracheal tube [Figures 1 and 2]. Upon re-examination, a K wire was visualized within the wall of the endotracheal tube, not violating the lumen of the tube. The wire was removed and the patient was subsequently extubated without further complications.


A difficult extubation: Endotracheal tube ensnarement by a Kirschner wire.

Davila VR, Schwab C, Papadimos TJ, Casabianca AB - Int J Crit Illn Inj Sci (2015 Apr-Jun)

Lateral view of skull. White arrow indicates K-wire that has inadvertently secured the endotracheal tube. Black arrow indicates edge of endotracheal tube. Rectangle indicates cervical spine
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4477394&req=5

Figure 2: Lateral view of skull. White arrow indicates K-wire that has inadvertently secured the endotracheal tube. Black arrow indicates edge of endotracheal tube. Rectangle indicates cervical spine
Mentions: Lateral and A-P radiographs were then obtained, in which a right-sided K wire appeared to impinge on the endotracheal tube [Figures 1 and 2]. Upon re-examination, a K wire was visualized within the wall of the endotracheal tube, not violating the lumen of the tube. The wire was removed and the patient was subsequently extubated without further complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, USA.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

After induction of general anesthesia, the patient was nasally intubated with a 7.0-cuffed endotracheal tube via the right naris... Prior to extubation, the patient was suctioned and the cuff deflated, but on withdrawal resistance was immediately met and the endotracheal tube could not be removed... Lateral and A-P radiographs were then obtained, in which a right-sided K wire appeared to impinge on the endotracheal tube [Figures 1 and 2]... Much is written about difficult intubation but little is written about difficult extubation... Previous case reports of resistance to attempted endotracheal tube removal fall into three main categories: (1) Physical impingement, (2) cuff malfunction, or (3) direct result of the surgical procedure... A popular practice is to snap the pilot bulb and valve off the pilot tube to deflate the cuff... This stretching maneuver actually occludes the pilot tube preventing cuff deflation... Finally, an endotracheal tube can become incorporated into the surgical field or compromised by the surgical procedure itself, especially during oral-maxillofacial surgery... In one report, the endotracheal tube was mistakenly incised and on removal the slit opened and subsequently caught on the hard palate preventing its removal... Ultimately, when dealing with an endotracheal tube that is difficult to remove, vigilance, sensibility, and caution are of paramount importance.

No MeSH data available.