Endotracheal Tube Kinking in the Prone Position during Pediatric Neurosurgery: A Case Report

Background: The prone position presents several concerns for the pediatric anesthesiologist, such as prevention of pressure related injuries, avoidance of undetected line infiltration, proper airway securement to inhibit unanticipated extubation, and limited access to the patient in critical events. However, the possibility of endotracheal tube kinking in pediatric patients is rarely discussed in the multitude of concerns about prone procedures. Here, we present a case report detailing the anesthetic management of a patient that experienced endotracheal tube kinking in the prone position during a posterior fossa mass resection. Our conclusion is that pediatric anesthesiologists must be cognizant of the possibility of endotracheal tube kinking in patients who are undergoing procedures in the prone position with significant neck flexion. We recommend using either an appropriately sized reinforced endotracheal tube or a nasotracheal intubation to decrease the potential of intraoperative tube kinking.