Nasal intubation is a commonly practiced airway management technique in oral and maxillofacial surgeries. Complications can occur at different levels during intubation through the nasal passage such as haemorrhage, turbinectomy and many cases reported even during extubation. This article describes a case of difficult extubation of naso-tracheal tube caused by the cuff inflation channel (pilot tube) encircling the inferior turbinate and logding between the turbinates. To our literary knowledge; no cases have been reported with such unique problem resulting in difficult extubation. This case report highlights that not only the tracheal tube or the cuff, but also the pilot tube can cause problems during extubation, and such an event is difficult to identify.
Introduction
General Anaesthesia through nasotracheal intubation is a commonly preferred technique in oral and maxillofacial surgery for an unhindered surgical field.1Several complications can occur during nasal intubation such as haemorrhage, retropharyngeal dissection, partial / complete turbinectomy and mucosal tears.2-4Difficult
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Premedication and induction of general anaesthesia was done as per institutional protocol. After lubricating the tracheal tube and right nostril with 2% lignocaine jelly, a 6.5 portex cuffed oral/ nasal endotracheal tube was introduced initially but due to resistance to further entry, a 6.0 cuffed endotracheal tube was successfully passed and fixed at 24 cm mark. Considering the cost of preformed nasal tubes and the affordability of our patient, we used an oral/ nasal tracheal tube for nasal intubation. Throat pack was placed in the pharynx under direct vision by larynoscopy. The only significant event in the intra-operative period was readjustment of tube tapes due to loosening of the tapes. The duration of surgery was three hours and was uneventful with minimal blood