Unexpected Ventilation Failure Following Intubation: Bronchospasm or Device Malfunction?

This case report describes the sudden intraoperative ventilation failure in an elderly patient undergoing thyroid lobectomy following intubation with a Medtronic neural integrity monitoring (NIM) endotracheal tube (ETT). Despite confirming appropriate tube positioning and initiating bronchodilator therapy, ventilation could not be restored until the NIM tube was removed and replaced with a standard ETT. This case predates a Class I FDA recall of Medtronic NIM tubes for design-related obstruction, raising the possibility that device malfunction may have contributed to the clinical presentation. This report highlights the importance of maintaining a broad differential diagnosis during airway emergencies and considering tube exchange early in the process.