Inability to ventilate while using a silicone-based endotracheal tube.
We present a complication associated with herniation of a specially designed silicone-based endotracheal tube (ETT) cuff used for laryngeal nerve monitoring (electromyographic [EMG] ETT). Lung ventilation in our patient was initially unimpeded. However, 30 minutes after initiation of anesthesia with desflurane and nitrous oxide, there was a sudden inability to ventilate due to the herniation of the ETT cuff presumably caused by diffusion of nitrous oxide into the silicone-based cuff. In vitro testing has shown that the increase in intracuff pressure during ventilation with nitrous oxide in the silicone-based EMG ETT is much greater (approximately 50 mmHg) than that in the polyvinyl chloride-based ETT (approximately 10 mmHg) routinely used in our department.
Gleich
Stephen J
SJ
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Nicholson
Wayne T
WT
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Jacobs
Travis M
TM
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Hofer
Roger E
RE
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Sprung
Juraj
J
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. Electronic address: sprung.juraj@mayo.edu.