A Challenging Extubation Caused by the Inability to Deflate the Cuff of an Endotracheal Tube

Background: Extubation is considered a critical event in general anesthesia. A smooth endotracheal intubation or an uneventful intra-operative period can still lead to a difficult extubation. This is a case report of an eventful and unanticipated difficult elective extubation in a post coronary artery bypass grafting patient. Observations: A knot was found on the pilot balloon tubing during extubation of the patient which made deflation of the endotracheal tube cuff almost impossible. After several minutes of troubleshooting, we were able to extubate the patient with stable hemodynamics without any evidence of sore throat. Significance: Rare cases and difficulties like these, challenge a healthcare provider to think beyond common knowledge and this serves as an example for other anaesthesiologists that how minute malfunctions in our common devices/instruments can lead to disastrous outcomes and hence vigilance is important.