An Unusual Cause of Extubation Failure: Surgical Fixation of the Endotracheal Tube With a Suture-A Case Report.

Technical difficulties encountered during endotracheal tube (ETT) extubation are rare but can precipitate catastrophic airway complications. We present the case of a 3-month-old male infant weighing 5.4 kg who underwent video-assisted thoracoscopic surgery (VATS) for a bronchogenic cyst excision. Following the procedure, initial attempts at extubation failed. Flexible fiberoptic bronchoscopy (FOB) identified that the ETT had been inadvertently sutured to the tracheal wall. Since this Vicryl suture also secured the surgical repair, extubation was delayed to avoid disrupting the anastomosis. On postoperative day three, the suture was safely transected from within the trachea using laser-assisted FOB. This case suggests that a post-procedural FOB examination could be a valuable tool for evaluating patency and anastomotic stability in selected high-risk airway reconstructions. It also highlights the importance of interdisciplinary communication and vigilance between surgical and anesthesia teams during complex thoracic procedures.