Pharyngeal Obstruction of a Reinforced Orotracheal Tube

Abstract

A variety of surgical procedures such as craniotomy, head and neck, and back surgery involve positioning the patient in a way that precludes the anesthesiologist's access to the airway. In these cases it is common to intubate the trachea with a reinforced endotracheal tube that is designed to allow bending but not obstruction. This is accomplished by embedding a metal wire in the wall of the endotracheal tube in a spiral fashion. Occasionally such patients require mechanical ventilation and intensive care postoperatively. Therefore, intensive care unit physicians, nurses, and respiratory therapists must recognize how reinforced endotracheal tubes differ from other endotracheal tubes. The major complication reported with the use of reinforced endotracheal tubes is related to the patient's biting on the tube, usually with the incisors (1,2). This causes bending of the embedded wire, and results in a permanent obstruction, commonly at the front of the mouth, which is easily recognized. We report a case of obstruction, unrelated to biting, that occurred in the pharynx and was not identified readily.