Flexometallic tubes are kink-resistant and extensively used in neurosurgeries. The manufacturers of flexometallic tubes recommend single usage. In low-income countries, due to the cost restraints, flexometallic tubes are commonly reused after ethylene oxide sterilization. With this technique, flexometallic tubes are effectively sterilized, but the physical integrity of the endotracheal tube cuffs may be compromised. Tube kinking and intraluminal blebs due to dissection are observed with the reused flexometallic tubes. These obstructions lead to difficulty in ventilation and inability to pass a suction catheter freely. Flexometallic tubes should be thoroughly checked for external deformity, cuff integrity, and tube patency for safe reuse.

Despite thorough assessment of reused flexometallic tubes, the partial unfurling of nylon spirals with distal herniation into the tube (panels A and B) may still happen intraoperatively, leading to dynamic obstruction resulting in variable resistance during suction catheter negotiation (see Supplemental Digital Content 1, video S1,...

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