Ventilation Insufficiency at the Beginning of the Anaesthesia

Introduction Airway management is critical for safe and successful anaesthesia. Careful preoperative evaluation and planning are essential, especially in cases of difficult airways [1,4]. We present a case of airway compromise caused by orogastric (OG) tube insertion and its management. Case Presentation A 77-year-old male was admitted to HLUHS for melanoma excision of the upper limb and axillary lymphadenectomy. He was 190 cm tall and weighed 135 kg, and general anaesthesia with tracheal intubation and controlled ventilation was planned. His medical history included controlled arterial hypertension and persistent atrial fibrillation. Preanesthetic evaluation revealed a difficult airway: sleep apnea (STOP-BANG questionnaire), Mallampati class IV, the inter-incisor gap of 3.5 cm, and a neck movement range of 90°. Tracheal intubation assisted by videolaryngoscopy was chosen. Anesthesia induction and bag-mask ventilation were successful with an OG tube. Tracheal intubation was uneventful (videolaryngoscopy CL view 2B), and artificial ventilation began. An OG tube was blindly inserted by an anesthesia nurse, after which the anesthesia machine showed a critical airway pressure drop, and the OG tube’s bag inflated. Connections of the breathing circuit were inspected and found intact. Gas flow was increased to maintain ventilation. Attempts to decrease gas flow again revealed airway pressure drops. Videolaryngoscopy confirmed the OG tube had been mistakenly inserted into the trachea, causing a gas leak. The OG tube was removed and reinserted under videolaryngoscopy guidance. The subsequent course was uneventful. Discussion International guidelines recommend thorough planning for difficult airways [1]. Videolaryngoscopy is effective for resolving such cases and has successfully resolved 93 % of difficult airway situations [5,6]. This case highlights that successful intubation does not ensure airway patency, as simple errors like OG tube misplacement can lead to significant complications [2,3]. A systematic evaluation of all possible causes of respiratory insufficiency is vital. Conclusions A thorough evaluation of all potential causes of respiratory insufficiency is essential in airway management to prevent complications and ensure patient safety [1,4].