Unusual case of endotracheal tube obstruction by caseous nec
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Tuberculosis is a social disease with medical implications. In spinal tuberculosis, surgery is performed for either deformities and neurologic deficits and/or drainage of cold abscess.

Endotracheal intubation is the cornerstone in the anesthesia practice; however, the tube itself may become a source of airway obstruction and problems due to the tube should be recognized and rectified immediately. We report an unusual case of endotracheal tube (ETT) blockage with a caseous necrotic material in a patient with spinal tuberculosis with no signs and symptoms of pulmonary tuberculosis. A 12-year-old girl was posted for decompression surgery for Pott's spine at the level of the dorsal 5th and 6th vertebra. The routine tests including chest X-ray were normal. The patient was on treatment with antitubercular drugs for 6 months. The sputum for acid-fast bacillus was negative. Clinical examination including auscultation of the chest was not significant. The surgery was performed with the patient in the prone position. The peak inspiratory pressure (PIP) was 18-20 cmH2O, oxygen saturation (SpO2) was 100%, and end-tidal carbon dioxide (EtCO2) was maintained between 32 and 35 mmHg. Sixty minutes later, there was a sudden increase in heart rate (HR), PIP, and EtCO2. HR increased up to 150/min, EtCO2 to 45-60 mmHg, and PIP to 40 cmH2O. However, SpO2 remained 100% all through the event. The ETT and circuit were checked and found to be patent and not kinked. There was minimal aspirate on suctioning. The tube position was undisturbed, but the breath sounds were decreased globally and there was a resistance in the bag on manual ventilation. Despite ensuring adequate analgesia and relaxation, the situation worsened. Immediately, the patient was turned to the supine position and ETT was changed to a new tube. The first tube was blocked with solid material. The ventilation was smooth now and the vital parameters set within the pre-event values. The patient was turned prone again. The surgery proceeded uneventfully until toward the closure when again there was an increase in the PIP, EtCO2, and HR. Again, there was a minimal thin aspirate on suctioning.....