REPETITIVE SELECTIVE ENDOBRONCHIAL INTUBATION DURING LAPAROSCOPIC CHOLECYSTECTOMY

Selective endobronchial intubation occurred three times in a 38-year-old female patient undergoing laparoscopic cholecystectomy. She weighed 58 kg and was 165 cm tall. Anaesthesia was obstained with propofol, fentanyl and vecuronium. Endotracheal intubation was carried out with a Malinckrodt tube, size 7.5. It was attached to the cheeks with the 22 cm marking at the teeth. The diagnosis of endobronchial intubation was made when he SpO2 fell abruptly to 79, 87 and 93 % respectively. Simultaneously, the peak inspiratory pressure increased and PetCO2 decreased. The third time, both lung fields were ausculated ; no breath sounds were found on the left side. The first two incidents were cured by exsufflating the artificial pneumoperitoneum. Pulling out the tube 4 cm definitely solved the problem. These endobronchial intubations were due to the tube being too close to the carina. During insufflation of the pneumoperitoneum, the carina is pushed upwards with the corresponding part of the mediastinum.