Bronchospasm Due to Malpositioned Esophageal Temperature Probe

To the Editor: We present an interesting complication of bronchospasm caused by a malpositioned esophageal temperature probe. The patient is a 42-yr-old, 87-kg man who presented for a single-level lumbar microdiscectomy. After atraumatic intubation with an 8.0-mm endotracheal tube, a 12-gauge esophageal temperature probe was inserted easily and without resistance. After placing the patient in the knee-chest prone position, breath sounds were bilateral and equal, without any leak. Surgery proceeded uneventfully for 1 h, with the patient being ventilated with a tidal volume of 900 cm3 and peak inspiratory pressures of 20–21 cm H2O. Temperature ranged from 36.0–36.2°C. At the conclusion of surgery, the patient was returned to the supine position, at which time we unsuccessfully attempted to remove the temperature probe. This precipitated severe bronchospasm, which was treated with albuterol, intravenous lidocaine, and deepening of the anesthetic with sevoflurane. The second emergence was without bronchospasm; however, it still was not possible to remove the temperature probe. The patient was extubated removing the endotracheal tube and the esophageal temperature probe as one unit; however, some force was required to remove the tube. Examination of the endotracheal tube revealed that the esophageal temperature probe was in a complete knot superior to the cuff (Fig. 1). After extubation, the patient was quite hoarse. He underwent fiberoptic laryngoscopy by an otorhinolaryngologist and was found to have no damage to the vocal cord structures and normal vocal cord motion.Figure 1: Endotracheal tube showing esophageal temperature probe in a complete knot superior to the cuff.There was no evidence of airway leak or unexpectedly low temperature reading to indicate that the temperature probe had been placed in the trachea. We believe that our attempt to remove the temperature probe had caused the knot to tighten, irritating the trachea and precipitating bronchospasm.