Airway Obstruction due to Huge Dried Mucous Plug Discovered during Induction of Anesthesia : A case report

Lee, Hae Jin; Moon, Se Ho; Jeon, Soon Shin; Lim, Young Hun; Chon, Jin Young

Case Report

General Article

Anesthesia and Pain Medicine 2008;3(1):67-70.
Published online January 30, 2008.

Airway Obstruction due to Huge Dried Mucous Plug Discovered during Induction of Anesthesia : A case report

Hae Jin Lee, Se Ho Moon, Soon Shin Jeon, Young Hun Lim, Jin Young Chon

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. anestha@catholic.ac.kr

Abstract

Endotracheal obstruction may cause serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and even brain death. A 21-year-old man was scheduled to undergo an open reduction for an orbital fracture. The patient had tracheostomy with an 8.0 mm tracheostomy tube 3 weeks ago and was breathing well spontaneously. When the cuff of tracheostomy tube was inflated for assisted manual ventilation and the induction of anesthesia, signs of partial endotracheal obstruction were observed, including high airway pressure, low tidal volume and high ETCO2. Large dried mucous plug was impacted in the tracheostomy tube. After removing this plug with a sterile surgical forcep, effective ventilation was recovered without complications. The case like this nearly fatal obstruction by large dried mucous plug was rarely reported, but it should be considered cautiously when a patient uses tracheostomy tube as an airway before general anesthesia.

Key Words: airway obstruction, anesthesia induction, mucous plug