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- W2008049305 abstract "We would like to thank the authors of a recent paper (Lucas & Yentis. Anaesthesia 2000; 55: 358–61) and letter (Barker et al. Anaesthesia 2001; 56: 189), which enabled us to avert a potential disaster, but point out that the use of the Intavent® tracheal tube can create its own problems. The Intavent® tracheal tube was used in an emergency for a patient requiring positive pressure ventilation of his lungs due to acute respiratory failure. This was secondary to a chest infection five days after a left upper lobectomy. The original anaesthetists had been unable to pass a double lumen endobronchial tube and had assessed him as Cormack and Lehane Grade 3, with a thyromental distance of 2 cm. It was possible to maintain oxygenation with a laryngeal mask airway while awaiting further expertise in the eventual passage of a single lumen tracheal tube. With this in mind, we performed an inhalational induction of anaesthesia and inspected the vocal inlet with a fibreoptic laryngoscope through a laryngeal mask airway. The trachea was intubated with the Intavent® tracheal tube railroaded over the laryngoscope and through an Intubating Laryngeal Mask Airway, chosen for the reasons given by Lucas and Yentis, and Barker et al. This was achieved easily despite oedematous vocal cords and a narrow aperture. We found, however, that ventilation was difficult and the airway pressure was about 40 cmH2O. It was also impossible to pass a suction catheter down the tracheal tube. Inspection with the fibreoptic laryngoscope revealed that the soft, flexible tip of the tube had folded over when being passed down the trachea, and that limited ventilation was possible through the ‘eye’, which was too narrow for the passage of the suction catheter. Gentle advancement of a gum elastic bougie remedied this and the airway pressures were immediately lowered. Whilst the Intavent® tracheal tube was ideal for the emergency situation, due to the tapered end fitting closely over the laryngoscope and not snagging on the vocal cords, the soft, flexible latex tip is vulnerable to compression and folding. The Intavent® tracheal tube is also not suitable for long-term ventilation as it has a low-volume high-pressure cuff, so we decided to exchange it over a gum elastic bougie. This was achieved with difficulty due to the conventional shape of the alternative tracheal tube. This reinforces the point made by Lucas and Yentis, Barker et al. and Jones et al. with regard to the shape of the tip of the tracheal tube." @default.
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- W2008049305 date "2001-07-01" @default.
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- W2008049305 title "Difficult airway - can intubate, 't ventilate" @default.
- W2008049305 doi "https://doi.org/10.1046/j.1365-2044.2001.02137-10.x" @default.
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