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November 5, 1973

Misadventure During Endotracheal Anesthesia

JAMA. 1973;226(6):675. doi:10.1001/jama.1973.03230060051029

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To the Editor.—  In The Journal (225:524, 1973), an accident caused by impaction of a suction catheter in an endotracheal tube was reported. The catheter had become disconnected from its adapter during suctioning, while the thorax was open and the patient in the left lateral position. When attempts to remove the catheter with clamps failed, extubation and reintubation with a new tube were performed. This, as the author states was a hazardous procedure since the patient was "in the lateral position... obscured by drapes and his chest... open." Indeed, under the described conditions, intubation may be impossible and emergency tracheostomy too late. A faster and safer method is to slowly withdraw the endotracheal tube (with its impacted catheter) and then to cut 1.27-cm sections of the endotracheal tube until the catheter becomes visible. At this time, the catheter is grabbed and pulled back for 5.08 cm. A new endotracheal tube