Procedural failure during catheter assisted laser safe endotracheal tube exchange (Preview)

The safe and competent use of the airway exchange catheters (AECs) is frequently required during head and neck surgery for bridging tracheal extubation, and for different endotracheal tube (ETT) exchange techniques associated with difficult airway management. Although the compatibility charts for the use of Cook airway exchange catheters (CAECs) with different ETTs have been developed by the manufacturer (Cook Medical, Bloomington, IN), they do not provide accurate guidelines for the special clinical circumstances described in our case report.

Case Presentation

A 56-year-old, ASA class 3 female presented for micro-direct laryngoscopy with carbon dioxide (CO₂) laser excision. She had a significant smoking history and bilateral vocal cord smoker’s polyps with a left laryngocele.

The patient’s past medical history was notable for hypertension and a subarachnoid hemorrhage over 10 years prior. She was intubated and ventilated in neuro critical care for 23 days at that time, but failed to wean from ventilatory support and had a tracheostomy performed. This was subsequently successfully decannulated after approximately 1 month. She had an appropriately functioning ventricular peritoneal shunt still in place. Preoperative laboratory values were unremarkable and vital signs included a blood pressure of 163/109, heart rate of 71 bpm, with an oxygen saturation of 98% on room air.

During the otolaryngology clinic visit, laryngeal videostroboscopy demonstrated normal gross vocal fold mobility and irregular glottic closure during sustained phonation testing. A large semi-pedunculated smoker's polyp on the right fold and a moderate smoker's polyp on the left fold with submucosal fullness were noted on examination. (Figure 1) Computerized tomography (CT) imaging also confirmed the general findings. Preoperative airway examination demonstrated...