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Intra Operative Difficulty in Ventilation: A Case Report

Narashima Reddy B, Prasad Kulkarni, Nirmala BC, and Ravi Shivaraman

We present a case of a 50 yr old female ASA I, who presented with hemangioma on the right side of the neck was posted for excision. Patient was shifted to operation theatre, intravenous (iv) line secured with 18gauge iv canula. Monitors connected .Induced and intubated. After 30 minutes of induction, we noticed difficulty in ventilation and tight bag since the patient was manually ventilated. There was fall in EtCO2 levels and later saturation. Auscultation revealed silent chest. Since the surgery involved dissection around the dome of right lung, pneumothorax was the first presumptive diagnosis. Patient was immediately ventilated with 100% O2. And a wide bore needle was inserted in right 2nd intercostal space which failed to relieve the resistance to ventilation. Endotracheal tube suctioning was done and the tube cuff was deflated but in vain. Patient was extubated and re-intubated with a fresh tube and the rest of the course of anaesthesia was uneventful. On inspection the extubated tube was found to be full of thick mucous secretions occluding the entire lumen of the tube. We present this case in view of the unusual cause for difficulty in ventilation in an ASA I patient with no history of previous lung infection. In this era of ventilation, incidental use of manual ventilation helped us diagnose the obstruction early. Mechanical obstruction is a rare & unanticipated cause of ‘tight bag’, unless intervened early could be fatal. The surprise is this is a rare cause of blocked ETT, reason of the mucous plug and from where did it come remains enigma