Transesophageal Echocardiography Induced Airway Obstruction in a Patient in Whom the Trachea Had Been Intubated via a LMA CTrach™

Abstract

To the Editor: Transesophageal echocardiography (TEE) may be used as a monitor for detection of venous air embolism in patients in the sitting position.1 Only two reports of airway compression in adults from TEE probe exist, none in neurosurgical patients.2,3 A 56-yr-old female was undergoing excision of a meningioma involving the sagittal sinus. The trachea was intubated via an LMA CTrach™ (The Laryngeal Mask Company Ltd., Le Rocher, Mahe, Seychelles) because of an anticipated difficult airway. A TEE probe (Vivid 7, GE Healthcare, Milwaukee, USA) was inserted to monitor venous air embolism. However, anteflexion of the probe was followed by a sudden increase in airway pressure from 22 to 34 cm H2O with reduced ventilation. After ruling out other causes, including light anesthesia when the probe was manipulated causing the patient to bear down and thereby cause an increase in airway pressure, the TEE probe was returned to a neutral position promptly restoring airway pressure to normal. Insertion and manipulation of a TEE probe may cause variety of complications.4 In this case, we speculate that acute anteflexion of the probe compressed the membranous part of trachea and the tip of endotracheal tube. This was worsened by fixed head flexion and the sitting position. The tip of the tube supplied with LMA CTrach is softer than the tip of a flexometallic tube, contributing to the TEE-induced airway obstruction. Sriganesh Kamath, MD, DNB, DM Nilay Chatterjee, MD, DM Suparna Acharya, MD, DNB, DM Subrata Kumar Singha, MD, PDCC Department of Anesthesia Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Kerala, India [email protected]