Life-threatening complication of recurrent laryngeal nerve monitoring with EMG reinforced silicone ETT.

We present 2 cases with complication of herniation of a specially designed endotracheal tube (ETT) cuff used for laryngeal nerve monitoring during thyroid surgery. Abrupt and total blockage of ventilation has occurred at 35th and 40th minutes of general anesthesia. In an animal trachea, we showed that overinflated cuff may herniate and block ETT tip easily. A 25-mm upward movement of the ETT is found as a contributing factor to cuff herniation.In patients intubated with electromyographic reinforced ETT, any event suggesting sudden ventilation blockage should be managed initially by prompt deflation of the cuff. The cuff should be inflated at the minimal necessary volume, and operating room staff should pay maximum attention to the stability of endotracheal and breathing tubes.