Partial Airway Obstruction with an Armored Tube by Swelling of the Inner Layer / 대한마취과학회지

An Armored tube is known to be the most effective in maintaining of airway patency during anesthesia in any position. Unfortunately, the tube itself may become the cause of airway obstruction. One of the known complications of the armored tube is a separation of the individual latex layers. This can be caused by herniation into the lumen. Diffusion of nitrous oxide into the inner hernia considerably intensifies the obstruction. The bubbles in the tube wall arise during manufacturing as well as during resterilization. A 62-year-old man with herniation of lumbar disc herniation was intubated with a 8.0 mm armored tube for general anesthesia. 30 minutes later, we experienced signs of partial endotracheal tube obstruction including high arterial PCO2 and inspiratory pressure in prone position. Then, tube suction with catheter was done and signs was slightly improved. But, 90 minutes later, passage of suction catheter was impossible. When operation was finished, patient was turned to supine position. We exchanged the tube with another tube and found inner wall herniation into the armored tube lumen caused by layer separation.

Partial Obstruction of an Armored Endotracheal Tube / 대한마취과학회지

An 47-year-old woman presented for a microscopic vascular decompression with facial nerve palsy. Past medical history was noncontributory. There were not abnormal physical or laboratory findings. Oral tracheal intubation with an armored tube was performed without any problems. Anesthesia was maintained uneventfully in spite of a high peak inspiratory airway pressure (28 30 cmH2O). After surgery, she had symptoms of airway obstruction and the endotracheal tube was removed. The removed tube was found to have a protrusion through almost all the length of tube which reduced its internal diameter a half. Finally, in any case of "airway obstruction" in an intubated patient, we should consider mechanical problems. We should keep in mind the presence of an armored endotracheal tube cannot be regarded as a guarantee of a patent airway. We must test not only leakage of the cuff but also passage of the tube prior to usage.

A Case Report of Airway Obstruction with Armored Endortracheal Tube / 대한마취과학회지

A fifty five year-old male patient was scheduled for a total laryngectomy under general anesthesia. A tracheostomy was performed on the administration day due to respiratory difficulty. All data of the preoperative routine check were within acceptable limits including incomplete RBBB on EKG. Just prior to starting the inhalation anesthesia, an armored tube (RUsch) was inserted instead of a silver cannula. Near the end of operation, signs of hypercapnia appeared as tachycardia and hypertension. Therefore, tracheobronchial suction was attempted but the suction catheter did not go through the armored tube. At that time, we decided there was an obstruction inside the tube. So, the armored tube was changed to a Portex tube. Thereafter, tachycardia and hypertension returned to normal intraoperative levels and we disocvered that the armored tube was obstructed almost completely by a blood clot.