Unusual case of difficult double-lumen endotracheal tube removal

Yazbek-Karam, Vanda G.; Haswani, Roula W.; Karam, Hoda S.; Haddad, Walid M.; Youssef, Pierre S.; Hachem, Boutros F.; Atik, Fouad T.; Rassi, Simon J.; Yammine, Joseph N.; Baraka, Anis S.; Aouad, Marie T.

doi:10.1016/j.jclinane.2008.10.017

« Previous Next »Journal of Clinical Anesthesia
Volume 21, Issue 7 , Pages 514-516, November 2009

Unusual case of difficult double-lumen endotracheal tube removal

Vanda G. Yazbek-Karam, MD (Clinical Associate)
- Department of Anesthesiology, Rizk Hospital, Beirut, Lebanon
- Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 110236, Beirut, Lebanon
Roula W. Haswani, MD (Staff Anesthesiologist)
- Department of Anesthesiology, Rizk Hospital, Beirut, Lebanon
Hoda S. Karam, MD (Staff Anesthesiologist)
- Department of Anesthesiology, Rizk Hospital, Beirut, Lebanon
Walid M. Haddad, MD (Staff Anesthesiologist)
- Department of Anesthesiology, Rizk Hospital, Beirut, Lebanon
Pierre S. Youssef, MD (Staff Surgeon)
- Department of Surgery, Rizk Hospital, Beirut, Lebanon
Boutros F. Hachem, MD (Staff Surgeon)
- Department of Surgery, Rizk Hospital, Beirut, Lebanon
Fouad T. Atik, MD (Staff Surgeon)
- Department of Surgery, Rizk Hospital, Beirut, Lebanon
Simon J. Rassi, MD (Staff Surgeon)
- Department of Surgery, Rizk Hospital, Beirut, Lebanon
Joseph N. Yammine, MD (Staff Surgeon)
- Department of Surgery, Rizk Hospital, Beirut, Lebanon
Anis S. Baraka, MD (Professor and Chairman)
- Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 110236, Beirut, Lebanon
Marie T. Aouad, MD (Associate Professor)
- Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 110236, Beirut, Lebanon
- Corresponding author. Tel.: +961 1 350 000x6380; fax: +961 1 744 464.

Received 13 October 2007; received in revised form 13 October 2008; accepted 30 October 2008. published online 09 September 2009.

Abstract

A reusable Robertshaw red rubber double-lumen endotracheal tube (DLT) was placed to facilitate lung isolation for thoracoscopy in a 49-year-old atopic patient. In spite of its smooth insertion, it was then not possible to remove the DLT. Direct laryngoscopy showed severe laryngeal edema. After 48 hours of medical treatment with steroids, the trachea was extubated. The laryngeal edema could have been the result of physical and chemical irritation by the reusable rubber DLT itself, or from the substances formed during repeated cleaning and sterilization of the DLT. Atopic patients who are prone to developing latex allergy are also more liable to develop severe reactions to chemical, mechanical, and physical irritation from reusable red rubber DLTs or from the chemical solution used for its cleaning and sterilization.

Keywords: Anesthesia complications, Latex allergy, One-lung ventilation, Tracheal extubation