A case with a constricted cuff lumen during the use of a spiral tracheal tube

A 65-year-old man was scheduled to undergo a tumor resection, neck dissection, and free forearm flap. We performed oral intubation using rapid induction. During the tracheotomy, when the tracheal wall was opened by the surgeon, we extubated the oral tube and inserted an 8.0-mm spiral tracheal tube into the tracheotomy aperture. We connected the cuff pressure meter to the pilot balloon and adjusted it to 20 cmH₂O. Circumferential wiring of the spiral tracheal tube was performed using 2-0 silk threads, and the tube was fixed to the nearby skin. We detected an air leak from the pharynx at 7 hours and 30 minutes after the start of the operation. At this point, the cuff pressure meter showed a pressure of 20 cmH₂O. We adjusted the cuff pressure meter to 30 cmH₂O, and the air leak subsequently disappeared. From that time onwards, we maintained a cuff pressure meter reading of 25-30 cmH₂O. After the operation, we connected a syringe to the pilot balloon and used the syringe to collapse the cuff, then extubated the spiral tube from the tracheotomy aperture to enable a tube exchange. At this time, the pilot balloon, but not the tube cuff, collapsed. After the anesthesia, we connected a cuff pressure meter to the pilot balloon and adjusted it to 20 cmH₂O. However, the tube cuff did not expand. In the present case, we believe that tube lumen stenosis occurred as a result of the circumferential wiring of the spiral endotracheal tube ; consequently, even when the pilot lumen pressure increased, the cuff pressure did not increase. Anesthesiologists should pay attention to stenosis of the tube lumen structure in cases requiring circumferential wiring of an tracheal tube.