A case report of difficult ventilation with the Combitube™ — valve-like upper airway obstruction confirmed by fibreoptic visualisation

Abstract

This case report describes difficulty with ventilation because of valve-like upper airway obstruction by aryepiglottic folds after uncomplicated insertion of a Combitube™ in a 30-year-old female patient. After correct (oesophageal) placement increased ventilation pressures occurred and a fibreoptic device was used to investigate the cause. Valve-like obstruction was discovered and subsequently observed during controlled ventilation. After removal of the Combitube™ and mask ventilation no valve mechanism was seen. This effect appeared to be due to an increased air stream caused by the obstruction of seven out of eight Combitube™ perforations.