Year: 2001
Type: letter
Abstract: We read with great interest the article (Hartmann et al. Anaesthesia 2000; 55: 670–5), in which the authors described the use of the Combitube (ETC) for gynaecological laparoscopy. We are also finishing a similar study in elective patients and we would like to comment on ETC use in anaesthesia. First, we congratulate the authors because they have provided an alternative to tracheal intubation for this type of surgery. In our country, airway management for gynaecological laparoscopy remains a challenge, mainly because we consider that no other device other than a tracheal tube can be used. Although published experience using laryngeal mask airway for gynaecological laparoscopy is available [1], we prefer not to use it for this type of surgery. We think that the laryngeal mask airway does not provide reliable protection of the airway against gastric content regurgitation in patients undergoing gynaecological laparoscopy. Wide variation in gastric content volume among patients is an important issue, especially when gastroesophageal reflux may not be clinically apparent. Other considerations are: high airway pressures may develop during surgery and the laryngeal mask airway may fail to provide adequate ventilation under this condition, and laryngeal mask airway fixation is not reliable and displacements might occur. Second, similar to Hartmann et al. and contrary to previous reports [2], we have observed a very low incidence of mild and transient postoperative pharyngeal symptoms with the ETC 37 F SA, either using blind or laryngoscopical insertion techniques [3, 4]. Third, ETC is a reliable device in managing failed intubations [5] in the anaesthesia setting and is a feasible device for elective patients. Thus, we are including ETC in many more elective surgical procedures, including gynaecological laparoscopy. However, we feel that ETC needs some improvements to enhance its current use in anaesthesia: 1 The pharyngeal balloon is rather rigid and could produce pharyngeal trauma, especially during prolonged surgery. Shifting to a high-volume/low-pressure balloon could solve this problem. 2 The tube should be bent without kinking its upper end. 3 A softer material for the tube would be an advantage According to a recent publication which suggests that re-sterilisation is possible [6], we re-use the ETC without problems. No other device provides good ventilation, airway protection, allows blind or laryngoscopic insertion, automatic and reliable fixation, and is so useful in the difficult airway. Thus, we strongly encourage the manufacturers to develop a new special model for anaesthesia use. Minor changes to such a remarkable device would make it more feasible for anaesthetic situations.
Source: Anaesthesia
Authors: R. M. Urtubia, J. Medina
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2007359627