Fiberoptic evaluation of the difficult extubation

Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation

We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube.

Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation

We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube.

Extubation of the surgically resected airway — a role for remifentanil and propofol infusions

PURPOSE

To report the use of propofol and remifentanil infusions to facilitate smooth extubation of a surgically resected airway.

CLINICAL FEATURES

A 19-yr-old man weighing 85 kg was scheduled for tracheal resection surgery following postintubation tracheal stenosis. He had a relatively long segment (4 cm) of his trachea resected and anastomosed. Postoperatively, he was sedated and electively ventilated for four days in a chin to chest position by stay sutures. In order to reduce any risk of traumatic disruption to the tracheal anastomosis, we planned to extubate his trachea under light general anesthesia. Attempts to extubate his trachea using propofol and alfentanil infusions failed. We used propofol and remifentanil infusions to achieve a state of sedate cooperation and extubated his trachea with fibreoptic bronchoscope guidance.

CONCLUSION

Propofol and remifentanil infusions in combination can facilitate successful extubation of the surgically resected airway with high risk of disruption.