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May 1, 1967

Endotracheal Tube Cuff Displacement

Author Affiliations

Brooklyn, NY

JAMA. 1967;200(5):420. doi:10.1001/jama.1967.03120180108030

To the Editor:—  A 58-year-old female patient, with a history of pulmonary emphysema, chronic bronchitis, arteriosclerosis, angina pectoris, and compensated congestive heart-failure, was scheduled for "pinning of the humerus," for nonunion of a left humerus fracture.Induction was carried out with sodium thiopental, followed by a high flow of nitrous oxide and oxygen, supplemented with methoxyflurane. Succinlycholine was given intravenously, and orotracheal intubation was performed with an orotracheal tube (36 Collins) and replaceable cuff.A few minutes after intubation, a progressively increasing respiratory obstruction developed, both inspiratory and expiratory. A thorough investigation of the airway and the anesthetic machine did not reveal any obvious reason for this. By auscultation, both lungs appeared to be ventilated although the breath sounds were distant.A sinus tachycardia soon developed, followed by ventricular tachycardia. At this time the patient became slightly cyanotic. The endotracheal tube was withdrawn about 1/2 inch, at which moment complete