Difficult extubation of a damaged neural integrity monitor electromyogram tracheal tube: A case report

The purpose of a neural integrity monitor electromyogram (EMG) tracheal tube is to reduce the risk of damage to the recurrent laryngeal nerves. Complications associated with the use of EMG tube are ventilatory failure, tracheal injury, and difficult extubation. We encountered a case of difficult extubation of an EMG tube after thyroidectomy and partial tracheal resection in a 73-year-old woman. The cuff was torn intraoperatively; but, it was kept inflated to maintain the integrity of the ventilatory circuit. During extubation, the vocal cord blocked the torn hole on the shoulder of the cuff, which subsequently was filled with air, complicating the extubation. We extubated the EMG tube slowly with the help of videolaryngoscopy with a moderate amount of force and re-intubated with a 6.0-mm ID endotracheal tube. We examined the airway during and after re-intubation using videolaryngoscopy. The findings were normal and no bleeding or laceration was observed. The subsequent recovery and extubation occurred smoothly. Awareness of the characteristics and types of damage that can occur in an EMG tube is essential. Because it can be difficult to ascertain the type of damage before extubation, communication between the surgeon and anesthesiologist, along with the preparation for emergency airway management are necessary for cases of difficult extubation.