A rare cause of intraoperative hypercarbia in the prone position: Cuff herniation versus internal damage of a reinforced flexometallic endotracheal tube

• Author Details:   
• Ashok Kumar Balasubramanian ^*

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An armoured tube is preferred in securing airways where kinking or obstruction is expected due to positioning or surgical procedure. We report an incident of intraoperative hypercarbia in an elective spine case in prone position with armoured tube. The various reasons for intraoperative hypercarbia include: kink in the breathing circuit, obstructed expiratory valve, exhaustion of soda lime, obstructed airways and ventilator malfunction. In this case, the above mentioned reasons were ruled out. The possibility of cuff herniation was anticipated and 1 ml of air was removed from the ETT cuff and ventilation improved immediately and ETCO2 was normalised. In this patient, cuff herniation may be the probable cause of hypercarbia. Hence the cuff of the endotracheal tube should be checked for any manufacturing defect before intubation although it is new. Fibroptic was done and endotracheal tube was found to be patent.