Loss of integrity of a reinforced endotracheal tube by patie
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A 30-year-old male patient, a victim of assault, underwent CSF leak repair, multiple scalp wound suturing and open reduction internal fixation of left ulna and patella under general anaesthesia. The airway was secured using a new disposable flexometallic endotracheal tube. After the reversal of neuromuscular blockade, the patient was breathing spontaneously through the endotracheal tube but gradually his breathing become irregular as he was biting on the tube. A loud whistling sound was heard with each inspiration effort.The patient was not getting ventilated adequately; his oxygen saturation was 80-85%. Additional dose of propofol and atracurium was given to control patient's ventilation. At this point it was realized that the patient had bitten the reinforced tube resulting in leakage through the tube. Patient was ventilated with a finger occluding the leakage till he again started breathing spontaneously. A second dose of neostigmine and glycopyrrolate was administered after which the trachea could be extubated uneventfully. The tube was found to be bitten and cut at one point with the wire coils intact.A reinforced endotracheal tube should not be taken as a safeguard against airway obstruction and the anaesthesiologist should be aware that reinforced endotracheal tube can get damaged due to bite of the patient. Use of an oral airway or bite block may prevent this complication from occurring...

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