USE OF THE RING‑ADAIR‑ELWYN (RAE) TUBE AS AN ALTERNATIVE FOR FLEXIBLE REINFORCED ARMORED TUBE FOR SUBMANDIBULAR APPROACH FOR ENDOTRACHEAL INTUBATION TO AVOID SURGICAL INTERRUPTION IN PATIENTS WITH PANFACIAL FRACTURES

Abstract

Background: Maxillofacil and dental surgery are challenges for the anesthetist, because the surgical procedures are just around the upper airway. So, the corner stone in the maxillofacial surgical patients is the patient safety during and after operation. Previous studies recommended the use of reinforced armored tube for submandibular tracheal intubation in maxillofacial surgical patients. The current study tested the RAE tube as an alternative technique to armored tube in the submandibular route for tracheal intubation in maxillofacial surgical patients. Objectives: The study aimed to compare the RAE tube as an alternative to flexible reinforced armored tube in submental endotracheal intubation in maxillofacial surgery. Methods: A total of thirty patients had undergone submental intubation for management of maxillofacial surgical procedures. The submandibular intubation by RAE tube was chosen in 15 patients as an alternative for flexible armored tube in another 15 patients when the oral and nasal intubation was not suitable and not safe for the surgical procedure. We excluded from the start the patient that required prolonged assisted ventilation because the tracheostomy is the preferred choice for all. Results: From November 2013 to November 2014, thirty patients with traumatic panfacial fractures were admitted to the Plastic Surgery and Burn Department at Al-Azhar University Hospitals within the subspeciality of Maxillofacial Surgery. Endotracheal oral intubation by laryngoscope was successful in all patients of the studied groups. No statistical difference was recorded between the studied groups as regard the time of intubation (9-13min), and no recorded intraoperative or postoperative major complications. Both types of the tube provided secured airway and an uninterrupted surgical access to the oral and nasal cavity. Also, it carried an access for good hemostasis and allowed intraoperative control of dental occlusion. The technique was found to be easy and convenient with uneventful intraoperative and postoperative periods. The technique was satisfactory to the surgeon, the anesthetist, the patients and the relatives. Conclusions: Submandibular tracheal intubation by RAE tube is an effective and useful technique for airway control in maxillofacial surgery. It can be used as a good alternative to reinforced armored tube in maxillofacial surgical patients.