Use of the Microcuff During General Anesthesia for Patients With Scoliosis.
Scoliosis may often be associated with a variety of cardiovascular and respiratory conditions or diseases, and depending on the severity of the spinal deformity, it may also complicate anesthetic management because of the difficulty of neck extension and tracheal deformity. Therefore, patients with scoliosis may require careful perioperative anesthetic considerations. A 14-year-old girl was scheduled to undergo extractions and restorative treatment for dental caries under general anesthesia. Her medical history was significant for intellectual disability and autism as well as previously undiagnosed scoliosis. After fixation of a 6.0 Portex endotracheal tube (ETT), percutaneous oxygen saturation (SpO) decreased to 93%, peak airway pressures increased, and unilateral lung ventilation was noted. Inadvertent mainstem bronchial intubation was immediately suspected, prompting removal of the Portex ETT and reintubation with a shorter 6.0 Microcuff ETT. The dental treatment was completed successfully without further incident. Assessment of the ETTs used intraoperatively led to the determination that the distance from the glottis to the carina was considerably shorter than normal for this patient. It was speculated that the Microcuff ETT may be optimal for anesthetic management of scoliosis patients because of its shorter lengths compared with other style ETTs, which may reduce the risk of bronchial intubation in such cases.