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전신마취 중 발생한 우발적 표시풍선 분리의 효과적 해결- 증례 보고 -

Effective Management for Incidental Detachment of the Pilot Balloon on the Endotracheal Tube- A Case Report -

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초록

A 57-year-old female with lumbar spinal stenosis at L4-S1 was scheduled to undergo posterolateral interbody fusion. Intubation with a 7.0 size ID cuffed reinforced tracheal tube (Mallinckrodt(TM), Mallinckrodt Medical Atholen, Ireland) was uncomplicated, and any air leakage was not detected at that time. Two hours after the start of operation, an air leak was apparent at the trachea during ventilation in the prone position. Closer inspection of the inflation tube and pilot balloon showed that the pilot balloon had become detached. Because she was being operated on in the prone position, and ventilation was only possible at a less than optimal state, we attempted to fix this without having to reintubate the patient`s trachea. Our solution involved inserting a 21-gauge needle into the inflation tube and a handheld aneroid manometer was then connected to it. The tube cuff was thereafter inflated up to a pressure of 20 cmH2O. In conclusion, careful manipulation is recommended when performing intubation and a needle connector may help secure the airway if the pilot balloon becomes detached during the procedure.

Abstract

A 57-year-old female with lumbar spinal stenosis at L4-S1 was scheduled to undergo posterolateral interbody fusion. Intubation with a 7.0 size ID cuffed reinforced tracheal tube (Mallinckrodt(TM), Mallinckrodt Medical Atholen, Ireland) was uncomplicated, and any air leakage was not detected at that time. Two hours after the start of operation, an air leak was apparent at the trachea during ventilation in the prone position. Closer inspection of the inflation tube and pilot balloon showed that the pilot balloon had become detached. Because she was being operated on in the prone position, and ventilation was only possible at a less than optimal state, we attempted to fix this without having to reintubate the patient`s trachea. Our solution involved inserting a 21-gauge needle into the inflation tube and a handheld aneroid manometer was then connected to it. The tube cuff was thereafter inflated up to a pressure of 20 cmH2O. In conclusion, careful manipulation is recommended when performing intubation and a needle connector may help secure the airway if the pilot balloon becomes detached during the procedure.

참고문헌 (7)

  1. Szekely SM, "The Australian Incident Monitoring Study. Problems related to the endotracheal tube: an analysis of 2000 incident reports", Anaesth Intensive Care, 21, pp.611~616 (1993)
  2. Rho EH, "Inadequate tidal volume: asymmetric endotracheal tube cuff inflation resulting in a massive persistent airway leak", Anesth Analg, 97, pp.1853~ (2003)
  3. Lewer BM, "Large air leak from an endotracheal tube due to a manufacturing defect", Anesth Analg, 85, pp.944~945 (1997)
  4. Swati, "Management of pilot balloon assembly malfunction in an armored endotracheal tube in a child", Paediatr Anaesth, 18, pp.356~357 (2008)
  5. 윤경봉, "Management of Detachment of Pilot Balloon During Intraoral Repositioning of the Submental Endotracheal Tube", Yonsei Medical Journal, 45(4), pp.748~750 (2004), 연세대학교의과대학
  6. Huang J, "A solution for occlusion of the pilot balloon tube on the endotracheal tube", J Clin Anesth, 20, pp.71~72 (2008)
  7. Rudlof B, "Intracuff saline infusion for the short-term repair of an endotracheal tube cuff leak", Anesthesiology, 90, pp.1801~ (1999)

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