An Unusual Cause of High Airway Pressures Using an Oesophageal Calibration Bougie in Bariatric Surgery- A Case Report

Background: Bariatric anaesthesia poses various challenges for the anaesthesiologist. We report a case of high airway pressures from the presence of the calibration bougie used in sleeve gastrectomy. This is the first time we have encountered raised airway pressures with the use of a calibration bougie. This underlines the need to be vigilant and consider the calibration bougie as a causative factor for raised airway pressures. Case presentation: The patient had a high Body Mass Index of 44 and no comorbid conditions. High airway pressures were noted on insertion of the calibration bougie by the anaesthesiologist. The common causes for intraoperative high airway pressures were ruled out and a fresh endotracheal tube was reinserted without any problems. After the second endotracheal tube was placed and the bougie was reinserted, the recurrence of the problem alerted us to the possibility of the bougie being the causative factor. With a change in ventilatory settings, the problem was circumvented and the procedure completed without any further problems. Conclusion: Bariatric anaesthetists should be aware that the calibration tube can lead to high airway pressures. This could be exacerbated especially if there are any unidentified underlying tracheal abnormalities. It is imperative to rule out the more common causes of high airway pressures. In retrospect it might have been useful to have used a reinforced endotracheal tube to determine if the problem recurred. Keywords: Calibration Bougie, Bariatric surgery, High airway pressure, Sleeve Gastrectomy