Successful detection and management of unexpected endotracheal tube kinking during neurosurgery - A case report

Kinking of endotracheal tube (ETT) is not an infrequent problem during general anesthesia. However, failure to secure free airway following airway obstruction due to kinking of endotracheal tube or other tube problems may lead to lethality instead of lifesaving. We describe a case of unexpected kinking of ETT intraorally while craniotomy was underway. The kink might result from over-bending of the softening tube in the oral cavity due to oral temperature and neck flexion. Early detection and immediate management of the ETT kinking may reduce the possibility of morbidity and mortality in anesthesia. It could be more difficult to carry out reintubation in such an awful situation when the operation was proceeding. In this case report we would like to highlight how to accurately and quickly diagnose and manage the ETT kinking intraorally while craniotomy was in process under anesthesia. Emphasis is also laid on the importance of properly positioning of the head and neck prior to any operation especially in craniotomy. Besides, the flexometallic (FM) or armoured endotracheal tubes may be good substitutes for the polyvinyl chloride (PVC) ones in preventing the ETT kinking during general anesthesia.