Rare Event of Intraoral Kinking of Endotracheal Tube Upon Prone Positioning in a Patient Undergoing Posterior Fossa Surgery

Abstract

A 10-year-old patient (Weight-28kg, Height-150cm), diagnosed case of cystic posterior fossa space occupying lesion with hydrocephalus was posted for craniotomy and excision under general anaesthesia in prone position. The patient was previously operated uneventfully under general anaesthesia for left medium pressure ventriculoperitoneal shunt in supine position. After standard general anaesthesia induction, the patient was intubated with 6.5 mm-cuffed/poly-vinyl-chloride (PVC) endotracheal tube (ETT). Unavail-ability of a wire-reinforced ETT of the desired size forced us to use the PVC tube. Endotracheal position was con fi rmed by bilateral chest auscultation and capnography. The tube was fi xed at 18 cm at oral margin after con fi rming the endotracheal location with fl exion and extension movement of neck. The patient was ventilated on a volume-controlled mode and end-tidal carbon dioxide was maintained between 30 and 35 mm Hg. Baseline peak airway pressure was noted to be 17cmH 2 O. Case speci fi c necessary vascular access were obtained. The patient was positioned prone after taking due precautions and a peak airway pressure of 18cmH 2 O was noted. Upon positioning of patient ' s head in Sugita head frame, peak airway pressures started to rise despite of maintaining two fi nger gap between chin and sternum, reaching a pressure limited peak pressure