Endotracheal Tube: A Shield yet Not a Safeguard during Paediatric Upper Gastrointestinal Endoscopy

Abstract This case report discusses a 1-year-old child with extrahepatic portal vein obstruction who underwent oesophagoduodenoscopy (OGD) for upper gastrointestinal bleeding under general anaesthesia. After an uneventful induction of anaesthesia and intubation, a 5.5 mm OD endoscope was inserted. After the CO 2 insufflation began, the airway pressures increased followed by failure to ventilate the lungs and the end-tidal CO2 (EtCO2) tracing was lost. The reasons for increased airway pressures during OGD and loss of EtCO2 trace were discussed. After the removal of OGD, the child exhibited signs of bronchospasm on auscultation. The issue recurred when the endoscope was reintroduced, further suggesting that the endoscope might be compressing the trachea, preventing ventilation. The report highlights that even with appropriately sized endoscopes for paediatric patients, because of the smaller and more pliable nature of the paediatric airway, the trachea can be compressed leading to ventilation issues. It underscores the importance of anaesthesiologists being aware of these risks and being prepared to manage airway complications during paediatric OGD procedures.