Intraoperative atelectasis due to endotracheal tube cuff herniation: a case report

Endotracheal tube [ETT] cuff herniation is a rare, and often difficult to diagnose, cause of bronchial obstruction. We present a case of outside cuff herniation of an endotracheal tube that caused pulmonary right lung atelectasis. A 29-year-old man ,a case of car accident with multiple fractures, was admitted to the emergency ward and transferred to the operating room[OR] for open reduction and internal fixation [ORIF] of all fractures .The procedures were done under general anesthesia [G/A]. The past medical history of the patient did not indicate any problem. Anesthesia was induced with thiopental, atracurium and then maintained by propofol and remifentanyl infusions and 100% O[2] via orally inserted ETT. The patient was positioned in left lateral decubitus position for operation. Two hours after induction of anesthesia, the oxygen saturation level dropped to 85% and the breath sounds in the right side of the chest were weakened. The chest x-ray images showed right lung atelectasis especially in the upper lobe. The problem was disappeared after removal of the ETT. In this case, we observed that an ETT cuff herniation can be a cause of airway obstruction. If there is a decreased unilateral breath sounds, we recommend replacement or repositioning of ETT.

[ effect of general versus spinal anesthesia on blood sugar changes during surgery]

Stress of surgery transfers some neurological and hormonal signals which triggers some physiological responses like adrenergic stimulation, increase in noradrenalin, cortisol, growth factor, decrease in insulin and increase in insulin resistance resulting in hyperglycemia during surgery. In this study a comparison is done between general anesthesia which by blocking brain's signals decreases reactions to the stress of surgery and hyperglycemia, and spinal analgesia which blocks hormonal and adrenergic reactions by peripheral effect. This randomized control clinical trial study was performed on 60 ASA I, II patients candidate of inguinal hernioraphy. The patients were randomly allocated to general anesthesia or spinal anesthesia with T12 level. Blood sugar of the patients was measured by glucometer 1 hour before the surgery and 1 hour and 6 hours postoperatively. There was no significant difference in blood sugar levels before the surgery between two groups but it was lower 1and 6 hours postoperatively in spinal anesthesia group. Spinal analgesia more effectively controls rises in blood sugar during the surgery and may be a suitable alternative for general anesthesia in patients with metabolic disorders