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The Parker Flex-Tip Tube Is Useful in a Bougie-Assisted Endotracheal Tube Exchange After Lung Lavage

2009; Elsevier BV; Volume: 24; Issue: 5 Linguagem: Inglês

10.1053/j.jvca.2009.08.004

1532-8422

Hirotoshi Kitagawa, Yasuhiko Imashuku, Toji Yamazaki,

Tracheal and airway disorders

In difficult intubation cases, a bougie is available for exchanging the endotracheal tube (ETT).1Ovassapian A. Yelich S.J. Dykes M.H.M. et al.Fiberoptic nasotracheal intubation: Incidence and causes of failure.Anesth Analg. 1983; 62: 692-695Crossref PubMed Scopus (146) Google Scholar When using a bougie, we have occasionally experienced difficulty in advancing the ETT, with its tip impinging on the epiglottis or vocal cords. In this situation, we inserted a Macintosch laryngoscope into the pharynx and then advanced the ETT through the laryngeal structures while viewing the epiglottis or glottis opening. The Parker Flex-Tip tube (Parker Medical, Englewood, CO) has a soft, flexible, curved, centered, distal tip.2Kristensen M.S. The Parker Flex-Tip tube versus a standard tube for fiberoptic orotracheal intubation: A randomized double-blind study.Anesthesiology. 2003; 98: 354-358Crossref PubMed Scopus (103) Google Scholar, 3Makino H. Katoh T. Kobayashi S. et al.The effects of tracheal tube tip design and tube thickness on laryngeal pass ability during oral tube exchange with an introducer.Anesth Analg. 2003; 97: 285-288Crossref PubMed Scopus (21) Google Scholar This superior, beveled tip tends to smoothly move through the laryngeal structures. We have found that the Parker Flex-Tip tube with a bougie can be smoothly advanced through the laryngeal structures into the trachea without a laryngoscope after lung lavage.A 42–year-old woman weighing 70 kg was scheduled for unilateral bronchopulmonary lavage because of pulmonary alveolar proteinosis. After the induction of anesthesia with propofol and rocuronium, a double-lumen tube (DLT) was inserted with the Pentax airway scope (Hoya, Tokyo, Japan). The bronchopulmonary lavage was smoothly performed. After completion of the 3-hour lung lavage, a change from a DLT to a single ETT was needed for postlavage ventilation. On a previous occasion, the exchange of a DLT for an ETT with an airway scope was disturbed by a flood of drained fluid. Therefore, in this case, a bougie-assisted intubation was chosen. The bougie was inserted into the left-side lumen of the DLT. Leaving the bougie in the trachea, the DLT was removed gently from the oral cavity. To avoid laryngeal trauma by reintubation of the ETT, we chose a Parker Flex-Tip tube as the single ETT. The Parker Flex-Tip tube (7.5-mm inner diameter) was mounted on the bougie and slowly advanced into the trachea. The Parker Flex-Tip tube was smoothly inserted without hitting or striking the laryngeal structures. The bougie-assisted conventional ETT was advanced through the laryngeal structures with the laryngoscopic view of the larynx, but the Parker Flex-Tip tube was smoothly advanced through the epiglottis and glottis opening without it. No postoperative sore throat or severe hoarseness was observed. The bougie-assisted Parker Flex-Tip tube facilitates smooth passage through the laryngeal structures without a laryngoscope. The Parker Flex-Tip tube is useful in exchanging the ETT with a bougie. In difficult intubation cases, a bougie is available for exchanging the endotracheal tube (ETT).1Ovassapian A. Yelich S.J. Dykes M.H.M. et al.Fiberoptic nasotracheal intubation: Incidence and causes of failure.Anesth Analg. 1983; 62: 692-695Crossref PubMed Scopus (146) Google Scholar When using a bougie, we have occasionally experienced difficulty in advancing the ETT, with its tip impinging on the epiglottis or vocal cords. In this situation, we inserted a Macintosch laryngoscope into the pharynx and then advanced the ETT through the laryngeal structures while viewing the epiglottis or glottis opening. The Parker Flex-Tip tube (Parker Medical, Englewood, CO) has a soft, flexible, curved, centered, distal tip.2Kristensen M.S. The Parker Flex-Tip tube versus a standard tube for fiberoptic orotracheal intubation: A randomized double-blind study.Anesthesiology. 2003; 98: 354-358Crossref PubMed Scopus (103) Google Scholar, 3Makino H. Katoh T. Kobayashi S. et al.The effects of tracheal tube tip design and tube thickness on laryngeal pass ability during oral tube exchange with an introducer.Anesth Analg. 2003; 97: 285-288Crossref PubMed Scopus (21) Google Scholar This superior, beveled tip tends to smoothly move through the laryngeal structures. We have found that the Parker Flex-Tip tube with a bougie can be smoothly advanced through the laryngeal structures into the trachea without a laryngoscope after lung lavage. A 42–year-old woman weighing 70 kg was scheduled for unilateral bronchopulmonary lavage because of pulmonary alveolar proteinosis. After the induction of anesthesia with propofol and rocuronium, a double-lumen tube (DLT) was inserted with the Pentax airway scope (Hoya, Tokyo, Japan). The bronchopulmonary lavage was smoothly performed. After completion of the 3-hour lung lavage, a change from a DLT to a single ETT was needed for postlavage ventilation. On a previous occasion, the exchange of a DLT for an ETT with an airway scope was disturbed by a flood of drained fluid. Therefore, in this case, a bougie-assisted intubation was chosen. The bougie was inserted into the left-side lumen of the DLT. Leaving the bougie in the trachea, the DLT was removed gently from the oral cavity. To avoid laryngeal trauma by reintubation of the ETT, we chose a Parker Flex-Tip tube as the single ETT. The Parker Flex-Tip tube (7.5-mm inner diameter) was mounted on the bougie and slowly advanced into the trachea. The Parker Flex-Tip tube was smoothly inserted without hitting or striking the laryngeal structures. The bougie-assisted conventional ETT was advanced through the laryngeal structures with the laryngoscopic view of the larynx, but the Parker Flex-Tip tube was smoothly advanced through the epiglottis and glottis opening without it. No postoperative sore throat or severe hoarseness was observed. The bougie-assisted Parker Flex-Tip tube facilitates smooth passage through the laryngeal structures without a laryngoscope. The Parker Flex-Tip tube is useful in exchanging the ETT with a bougie.