Damage to the cuff of EMG tube at endotracheal intubation by using a lightwand -A case report-

Difficult extubation of a damaged neural integrity monitor electromyogram tracheal tube: A case report

INTRODUCTION

The purpose of a neural integrity monitor electromyogram (EMG) tracheal tube is to reduce the risk of damage to the recurrent laryngeal nerves. Complications associated with the use of EMG tube are ventilatory failure, tracheal injury, and difficult extubation.

PATIENT CONCERNS

We encountered a case of difficult extubation of an EMG tube after thyroidectomy and partial tracheal resection in a 73-year-old woman.

DIAGNOSES

The cuff was torn intraoperatively; but, it was kept inflated to maintain the integrity of the ventilatory circuit. During extubation, the vocal cord blocked the torn hole on the shoulder of the cuff, which subsequently was filled with air, complicating the extubation.

INTERVENTIONS

We extubated the EMG tube slowly with the help of videolaryngoscopy with a moderate amount of force and re-intubated with a 6.0-mm ID endotracheal tube.

OUTCOMES

We examined the airway during and after re-intubation using videolaryngoscopy. The findings were normal and no bleeding or laceration was observed. The subsequent recovery and extubation occurred smoothly.

CONCLUSIONS

Awareness of the characteristics and types of damage that can occur in an EMG tube is essential. Because it can be difficult to ascertain the type of damage before extubation, communication between the surgeon and anesthesiologist, along with the preparation for emergency airway management are necessary for cases of difficult extubation.

Laryngeal nerve monitoring

Intraoperative neurophysiological monitoring of the vagus and recurrent laryngeal nerves is increasingly used during thyroidectomy, parathyroidectomy, skull base surgery, and cervical discectomy with fusion. Monitoring can assist in nerve localization and in reducing the incidence of neural trauma. To be effective, however, monitoring must be correctly implemented and the results interpreted based on an in-depth understanding of technique and the surgical structures at risk. Because "poor monitoring is worse than no monitoring" all members of the surgical monitoring team must have training specific to laryngeal recording to maximize its benefit and minimize pitfalls. This publication will review pertinent anatomy and neurophysiology as well as technical and interpretative factors.