Is the Combitube a useful emergency airway device for anesthesiologists?

Abstract

To the Editor: We would like to compliment Bishop and Kharash [1] for their insightful investigation regarding the Combitube[trade mark sign]. However, the authors failed to mention which tube size was used in their study-we assume it was the ETC Combitube[trade mark sign]. The size of the tube originally recommended by the manufacturer is 41F (Combitube[trade mark sign]) for adult patients taller than 5 ft (152 cm). In 1995, the Combitube[trade mark sign] SA was approved for patients between 4 and 5 ft (122 to 152 cm). Similarly, we found this limit questionable and, considering the bulky design of the standard ETC Combitube[trade mark sign], decided to test the smaller ETC SA in patients exceeding 5 feet in height. We are able to report 104 patients (66 male, 38 female; 3.93-6.5 ft [120-198 cm]) who received the Combitube[trade mark sign] SA during general anesthesia; most often during automatic implantible cardioverter defibrillator implantation. The duration of the procedures ranged from 45 to 360 min. In each case, we were able to document with the use of pulse oxymetry, capnometry, and ventilation parameters that our patients could be oxygenated and ventilated adequately. The oropharyngeal cuff volume of 85 mL, recommended by the manufacturer, was sufficient in 71 patients (68%). The remaining 33 patients required an additional insufflation volume of 25-50 mL in the oropharyngeal balloon to prevent air leakage. We conclude that the Combitube[trade mark sign] SA can be instituted without restriction in patients exceeding 5 feet in height. The exact upper limit of height remains open for further discussion. Due to its smaller size, the Combitube[trade mark sign] SA is easier to use and seems to be less traumatic to soft tissues. As previously mentioned [2], we prefer to use a laryngoscope during insertion of the Combitube[trade mark sign] SA. This seems to reduce the number of intubation failures. In conclusion, we would like to emphasize the importance of the authors' contribution, particularly regarding the use of a laryngoscope, and we would like to recommend the primary use of the Combitube[trade mark sign] SA independent of an upper height limit. Roland Walz, MD Shawn Davis, EMT-P Bernhard Panning, MD Department of Anesthesiology and Intensive Care Medicine; Medizinische Hochschule Hannover; 30625 Hannover, Germany