Anaesthetic Management of a Patient with Endotracheal Tuberculosis Posted for Endoscopic CSF Leak Repair

Abstract

Introduction: Patient with tracheal tuberculosis with active lung infection requiring Intubation using Double lumen Endotracheal tube pose a challenge to anesthesiologist to prevent contamination of healthy lung. Case Report: 55 year female presented with complaints of nasal discharge for 2 weeks, cough with expectoration for one week. A diagnosis of CSF Rhinorrhoea was made. HRCT chest report showed tree in bud opacities suggestive of TB. General anaesthesia was planned. Preoperatively nebulized with Lignocaine with adrenaline; Patient was Pre medicated, Preoxygenation done with 100% oxygen. Induced with Inj Propofol. 35F Left Double lumen tube was inserted under fibreoptic guidance and was confirmed by chest rise and ETCO2 and Tube fixed in place. A portable ventilator was used with Tidal volume of 5ml per kg for the right lung and regular ventilator with same tidal volume to left lung. Intra operative vitals were stable throughout the procedure. The patient was extubated after adequate spontaneous efforts. After extubation the patient started desaturating, saturation went upto 70% on room air, immediately the patient was reintubated and shifted to ICU with ET tube insitu. The patient was extubated in ICU after 2 days and shifted to postoperative ward. Conclusion: In patients with active lung infection a plan for Double lumen ET tube may help in avoiding the infection spreading to healthy lung, intubation period is crucial to avoid most common problems such as malposition, airway trauma and tension pneumothorax caused by high ventilating pressure or large tidal volumes in patients.