Expert: Ronald Levy, M.D. - 12/5/2006

Question
During prep for back surgery and general anesthesia, there was difficulty in inserting a breathing tube.  This was explained as having found an obstruction.  A smaller tube was then inserted and surgery proceeded.  Now told that airway has swelled, therefore being kept under anesthesia and on respirator until a specialist can be brought in tomorrow. What would cause swelling and is it normal to remain on respirator?  What questions should we be asking?

Answer
There are 2 issues here. The first is: What was the problem with the intubation. If the airway was abnormally narrowed (for whatever reason) then to remove the tube before evaluation may cause the airway to close completely. The 2nd question is: What would cuase the swelling. The manipulations that the anesthesiologist did to try to intubate could cause soft tissue swelling which could also close off the airway if the tube is removed. I would recommend waiting until the specialists can see the patient and evaluate what the underlying cause is. Being on the ventilator is uncomfortable but still better than not breathing!

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston