Showing papers on "Combitube published in 1997"

Esophageal rupture associated with the use of the Combitube

Abstract: I n many parts of the world, the Combitube’” (Sheridan Catheter Corp., Argyle, NY) is used for difficult airway management (1,2) and for aiding airway management during cardiorespiratory arrest, including those managed by nonanesthetic personnel (3). Similarly, in the United Kingdom, the laryngeal mask airway (LMA) is a useful device for airway management by nonanesthetic staff during cardiac arrest (4). The LMA consists of a flexible curved tube opening at the distal end into the lumen of an elliptical mask that has an outer inflatable rim. Proximally, the tube is joined to a standard 15-mm connector (5). The LMA fills a niche between the face mask and the endotracheal tube in terms of anatomical location and invasiveness. Once placed, it sits with its tip in the hypopharynx, between the respiratory and gastrointestinal tracts, and forms a circumferential lowpressure seal around the glottis (5). Because the LMA does not protect from aspiration of gastric contents (5), the Combitube’” esophageal airway may offer an advantage over the LMA during cardiopulmonary resuscitation. We assessed the ease of insertion and effectiveness of ventilation of the Combitube’” in comparison with the laryngeal mask when used by anesthetic staff in a controlled, randomized, prospective study. Because the Combitube’” is not widely used in the United Kingdom, our first step was to familiarize ourselves with inserting the airway. The incident in this case report occurred during our familiarization with the CombitubeTM. This trial had been approved by our local research ethics committee.

Bronchoscopy via a redesigned Combitube in the esophageal position. A clinical evaluation.

Abstract: Background : The esophageal-tracheal Combitube (Kendall-Sheridan Catheter Corp., Argyle, NY) is an effective device for providing adequate gas exchange. However, tracheal suctioning is impossible with the Combitube placed in the esophageal position. To eliminate this disadvantage, the Combitube was redesigned by creating an enlarged hole in the pharyngeal lumen that allows fiberoptic access, tracheal suctioning, and tube exchange over a guide wire. Methods: The two anterior, proximal perforations of regular Combitubes were replaced by a larger, ellipsoid-shaped hole. After the study was approved by the institutional review board, 20 patients with normal airways (Mallampati I or II) were studied. During general anesthesia, patients were esophageally intubated with the Combitube. A flexible bronchoscope was inserted and guided via the modified hole and glottic opening down the trachea. For the replacement procedure, a J tip guide wire was introduced through the bronchoscope. The bronchoscope and the Combitube were removed and a standard endotracheal tube was advanced over a guide catheter. Results: Bronchoscopic evaluation of the trachea and guided replacement of the Combitube by an endotracheal tube was successful in all 20 study patients. The average time needed to perform airway exchange was 90 ± 20 s (mean ± SD). Arterial oxygen saturation and end-tidal carbon dioxide levels remained normal in all patients. No case of laryngeal trauma was observed during intubation or the airway exchange procedure. Conclusions: The redesigned Combitube enables fiberoptic bronchoscopy, fine-tuning of its position in the esophagus, and guided airway exchange in patients with normal airways. Further studies are warranted to demonstrate its value in patients with abnormal airways.

Lost Airway During Anesthesia Induction: Alternatives for Management

Abstract: Pediatric and adult patients with upper airway obstruction pose several challenges to the anesthesiologist and otolaryngologist--head and neck surgeon. The initiation of general anesthesia and endotracheal intubation may progress to complete life-threatening respiratory decompensation with failure to achieve endotracheal intubation or mask ventilation. Hurried invasive maneuvers such as large-bore needle tracheal entry and cricothyrotomy are recognized salvage techniques, but other modes of extratracheal ventilation are now possible before surgical airway procedures are required. The laryngeal mask airway and esophagotracheal Combitube (Kendall Sheridan Health Care Products Co., Argyle, NY) are described, with examples of their clinical application. The combined technique of anterior commissure laryngoscopy and intubation with the gum elastic bougie is the preferred alternative for achieving tracheal entry when extratracheal ventilation cannot be accomplished. An algorithm for joint management of the problem airway by anesthesiologist and otolaryngologist--head and neck surgeon is illustrated.

A complication of percutaneous tracheostomy whilst using the Combitube for airway control

Abstract: We report the occurrence of oesophageal perforation and dilatation during percutaneous tracheostomy. The Combitube was used for airway maintenance during this procedure. This case highlights the limitations of the Combitube when used in this situation.