title: Intraoperative aspiration in a paediatric patient.
abstract: Aspiration around uncuffed endotracheal tubes in paediatric patients is an uncommon event. Uncuffed endotracheal tubes are commonly used in paediatrics even when the risk of gastric aspiration is significant. A case history is presented of an 81/2-year-old who aspirated during a laparotomy for bowel obstruction. The patient was intubated with an uncuffed #6.0 Portex endotracheal tube. A small leak was noted during positive pressure ventilation. The aspiration was significant such that the patient required 24 hours of positive end-expiratory pressure (PEEP) in an intensive care unit. Uncuffed endotracheal tubes are used because post-intubation stridor is minimized, the lungs are compliant and the funnel-shaped trachea is more likely to secure the airway from aspiration. An uncuffed tube however, does not completely seal the airway, particularly in the presence of an audible "leak." As a result of this case, we now consider the use of a cuffed endotracheal tube in children whenever a 5.5 internal diameter or larger is required. When the risk of pulmonary aspiration is present, the cuff is inflated to reduce the likelihood of contamination of the airway.
mesh_terms: D000402:Airway Obstruction / Q000209:etiology*; D002648:Child; D004868:Equipment Failure; D006801:Humans; D007082:Ileum / Q000098:blood supply; D007415:Intestinal Obstruction / Q000601:surgery*; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D007511:Ischemia / Q000601:surgery; D008297:Male; D013396:Suction