A 50-year-old man had symptoms of hoarseness, sore throat, and difficult swallowing for one year. He was a heavy smoker and in recent months had noticed some shortness of breath. Roentgenograms showed mild pulmonary amphysema and subglottic tumor formation. Biopsy of the larynx established the diagnosis of epidermoid carcinoma, and laryngectomy with radical neck dissection was planned.
Preoperative sedation with meperidine hydrochloride and atropine sulfate was satisfactory, and induction of anesthesia was accomplished easily with nitrous oxide, oxygen, and halothane. A moderate depth of anesthesia, as determined by clinical signs, was maintained. Respirations were assisted and compliance was satisfactory. The skin incision was designed to allow low tracheostomy. Although some bubbles had been noticed in the midline as the trachea was being dissected, things went quite smoothly until tracheostomy was performed.
Shortly after an anode endotracheal tube with inflated cuff was properly placed in the distal tracheal stoma, impedance to