An Unprecedented Complication, never seen ,never heard in My 17-Year Career in Anesthesia
A recent adenotonsillectomy for a 10-year-old girl showcased the extraordinary adaptability and quick thinking of a surgical team. The procedure, performed on a healthy patient (ASA I), began routinely with a smooth nasotracheal intubation using a 5.5 ID PVC endotracheal tube (ETT). However, during surgery, the ENT surgeon identified a unique complication: the ETT had unexpectedly broken, with its distal segment lodged in the trachea.
The team’s immediate response highlighted their expertise. Despite challenging conditions, including limited visibility due to bleeding, they swiftly stabilized the patient’s oxygen levels using a smaller 3.5 ETT. Without access to a fiberoptic bronchoscope, the team embraced innovation. Imaging confirmed the position of the broken tube near the vocal cords, and a nephroscope, paired with a PCNL grasper, was expertly utilized to extract the fragment. The surgery proceeded seamlessly, and the patient was successfully re-intubated and ventilated. Post-procedure, the patient experienced brief laryngospasm during extubation, which was managed effectively. She made a full recovery and was discharged in stable condition the next day. This extraordinary case underscores the importance of teamwork, creativity, and preparedness in overcoming even the most unique challenges, ensuring the highest standards of patient care.