Respiratory Difficulties Encountered During Posterior Fossa Exploration

Abstract

This report describes an unusual case of obstruction of a reinforced endotracheal tube during posterior Fossa exploration to excise glioma tumor. An 11-year-old male child, scheduled for excision of a glioma in the prone position. The trachea was intubated using a 5.0-mm nylon reinforced latex endotracheal tube (TT). The anesthesiologist ventilated his lungs with a mixture of isoflurane 1.0 MAC in oxygen (35%) and medical air. It was observed that his peak airway pressure was 21 cm H2O at the beginning of anaesthesia, increased to 26 cm H2O over three hours. After that and over 30 min, the peak reached 35 cm H2O, while the end-tidal CO2 pressure was 45 mmHg then gradually increased to 100 mmHg. The anesthesiologists suspected partial obstruction of the tracheal tube (TT). However, the anesthesiologists could not pass a suction catheter through the TT. The anesthesiologist could not advance a suction catheter beyond 8 cm. Re-intubation of the trachea with a 5.5 mm PVC TT relieved the airway obstruction. The termination of surgery allowed to take a chest x­ray which revealed unimpressive marginal pneumothorax which was drained but did not relieved the difficulties. The recording of tissue oxygen saturation and end tidal CO2 were consistent with gradual subtotal obstruction which allowed oxygenation, and delivering inhalational agent but retention of carbon dioxide. In this report we described an unusual incidence of tracheal tube obstruction complicated by presence of small pneumothorax which was successfully treated.