Canadian Journal of Anesthesia 50:526-527 (2003)
© Canadian Anesthesiologists' Society, 2003
An unusual cause of difficulty confirming correct placement of an endotracheal tube
Arie Peliowski, MD and
Chris Christodoulou, MB CHB
Winnipeg, Manitoba
To the Editor:
An otherwise healthy 46-yr-old man underwent circumferential cervical spine decompression and instrumented fusion. Due to the patient’s neurologic symptoms, the surgeon requested that the intubation be done awake. After topicalization of the airway and insertion of the endotracheal tube, a regular end-tidal carbon dioxide waveform and misting of the tube were both observed to be present. In addition, the patient could no longer speak. After iv induction, the patient’s breathing was assisted with manual ventilation, and the chest was seen to rise with each breath. When auscultation of the chest was performed to confirm that breath sounds were equal and bilateral, no breath sounds were heard. The end of the stethoscope was examined, and the diaphragm was tapped with a fingertip, which was easily heard. Repeat auscultation of the chest resulted in no breath sounds being detected. The end of the stethoscope was rotated, and the bell was tapped with a fingertip, which again was easily heard. When the chest was auscultated with the bell, still no breath sounds were detected. At this point, a problem with the stethoscope was suspected, and auscultation with a different stethoscope confirmed that air entry was equal bilaterally. The case proceeded uneventfully.
Upon initial inspection, the stethoscope in question (Littman, Cardiology II S.E., age approximately eight years) appeared to be intact and undamaged. Upon extension of the plastic tubing and closer inspection, the tubing was seen to be cracked, and nearly transected midway along its length. With the tubing flexed/curled, the edges of the crack remained approximated and the stethoscope appeared to function normally (Figure 1
). When the tubing was straightened or extended, the edges of the crack separated, and nothing could be heard (Figure 2). The stethoscope had been functioning normally the previous day, and no snapping or cracking sound indicating damage was heard. We are not aware of any previous report of the sudden cracking of a stethoscope’s tubing, and this was confirmed with a Medline search. Just as the anesthetic machine is checked on a daily basis, our other equipment must also be examined regularly in order to detect damage or malfunction, which can occur at any time.
