Case 49: A Leaking Endotracheal Tube in a Prone Patient
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You are to anesthetize a 30-year-old man (200 lb) who is donating his bone marrow to an unknown person. He is classified as an ASA 1 with a class 1 airway. The patient has had no previous anesthesia/surgery, and his family history is negative for anesthesia-related complications. He takes no medication and has no drug allergy. An IV is placed in his left hand, and midazolam (2 mg) is given in the preoperative holding area with good effect. He is anesthetized in a routine manner and mask ventilation is uneventful. After the airway is secured with an endotracheal tube, the patient is turned prone. His head is turned to the side so that you can see both eyes. Everything is progressing as planned until 30 min before the end, when you notice that there is a progressive cuff leak in the ETT. With 10 min to go, you are eventually unable to blow up the cuff. At this point, the patient’s vital signs remain stable, but the oxygen saturation has decreased from 100% to 96%. The peak pressure has fallen from 36 cm H2O to 22 cm H2O.