Parker Flex-Tip Tube Research Articles

A study to evaluate and compare Parker Flex-Tip tube and polyvinyl chloride endotracheal tube for hemodynamic response during intubation

Abstract Background and Aims: Both laryngoscopy and endotracheal intubation individually contribute to hemodynamic pressor response following endotracheal intubation. Parker Flex-Tip tracheal tube has a flexible, curved, smooth, centered, and tapered distal tip that is designed to facilitate rapid, easy, and nontraumatic intubation. The present study was conducted to compare Parker Flex-Tip and polyvinyl chloride (PVC) endotracheal tube (ETT) for hemodynamic response during intubation. Materials and Methods: Sixty patients of either sex of age 18–50 years, belonging to the American Society of Anesthesiologists (ASA) physical Status I or II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included. In Group I (n = 30), Parker Flex-Tip tube was used and in Group II (n = 30), PVC ETT was used. Heart rate (HR), systolic blood pressure, diastolic blood pressure (DBP), and mean arterial pressure were compared at various time intervals. Quantitative variables were compared using unpaired t-test and qualitative variables were compared using Chi-square test. P ≤0.05 was considered statistically significant. Results: The mean basal value of HR was 81.33 ± 13.78 beats/min in Group I and 87.36 ± 13.34 beats/min in Group II (P = 0.09). The difference between both the groups was found to be comparable at baseline, prelaryngoscopy, and just after laryngoscopy (AL) but this difference was found to be statistically significant just after intubation (AI) and at 1 min AI. In both groups, DBP started increasing just AL but the difference was not significant. This difference between the two groups was observed to be statistically significant at 1 min AI (81.73 ± 13.29 in Group I vs. 88.96 ± 10.27 in Group II, [P = 0.02]). Conclusion: Parker Flex-Tip tube is beneficial in controlling the hemodynamic response during laryngoscopy and intubation. This effect is significantly evident in HR and DBP.

Integrated Assessment of Discrepancy Between Tracheal Tube and Tube Exchanger as Advancement: A Manikin Simulation Study.

Advancing a tracheal tube over a tracheal tube exchanger into the trachea frequently causes difficulties because of the tube impingement on laryngeal structures. In the present study, we measured the resistance of tube advancement both objectively and subjectively with a variety of combinations of tube exchanger sizes and tracheal tubes using a manikin simulator. Lubricated 7.5 mm ID standard and Parker Flex-Tip (PFT) tracheal tubes were railroaded over the tube exchangers (OD 1-6 mm) into the trachea through the oral route in a manikin. Consequently, 12 combinations of tracheal tube-exchanger tube assemblies were evaluated. Tube advancing resistance at the laryngeal inlet was subjectively evaluated. The objective tube advancing resistance (force) at the laryngeal inlet was evaluated using a digital force gauge. The execution of each tracheal tube-exchanger trial was conducted 10 times. With a 1-mm tube exchanger, all intubation attempts with both standard and PFT tubes failed. Esophageal intubation or severe impingement at the right arytenoid accompanied with a bent tracheal tube was observed. With a 2-mm tube exchanger, during intubation with a standard tracheal tube, rotation of the tube was sometimes required; however, all other intubations were done without problems. When PFT tubes were used, all intubation attempts were performed without problems. The rest of the trials were successfully performed regardless of the combinations of tube exchangers and tracheal tubes; however, one attempt of intubation with a combination of a 5 mm tube exchanger and a standard tracheal tube required withdrawal and rotation of the tube because of impingement at the epiglottis. In cases where there was no gap resistance, which means tube advancing resistance generated by a gap between an introducer and a tracheal tube, the pressing force was approximately less than 10 N. However, in the cases requiring some interventions to overcome the gap, the pressing force reached around 15 N. When intubation failed, for example when the tube bent, or esophageal intubation, the pressing force reached around 30 N. Impingement due to the gap between the tube exchanger and the tracheal tube is thought to occur in the PFT tube less frequently. Once an impingement occurs, we can feel approximately twice the amount of resistance as usual, which may be a chance to consider taking some interventions. When the impingement is not released, regardless of interventions, excessive force may result in esophageal intubation or tracheal injury.

A study to compare Air-Q intubating laryngeal airway with Ambu Auragain laryngeal mask for blind tracheal intubation using Parker flex tip tube.

Background and Aims:A number of supraglottic airways have been developed to facilitate the passage of tracheal tubes. Various studies have been conducted using air-Q ILA as a conduit for endotracheal intubation. Ambu AuraGain is a newer 3rd generation supraglottic airway device. There are limited studies available in literature on blind tracheal intubation through the Ambu AuraGain. This study was designed to compare air-Q ILA and Ambu AuraGain as conduit for blind tracheal intubation using Parker flex tip tube.Material and Methods:One hundred twenty patients of either sex, aged 18-60 years, belonging to ASA physical status I or II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included in the study. Patients were randomly allocated to one of the two groups. Group A (n = 60) included blind intubation through air-Q ILA using Parker flex tip tube and group B (n = 60) included blind intubation through Ambu AuraGain using Parker flex tip tube.Results:The first attempt success rate was significantly more in group A (P < 0.001). Intubation was significantly easy in group A as compared to group B (P < 0.001). The mean time for insertion of endotracheal tube through air-Q ILA in group A was 17.85 ± 6.25 sec while in group B it was 30.19 ± 10.97 sec (P < 0.001).Conclusion:Air-Q ILA resulted in significantly more success rate and ease of intubation as compared to Ambu AuraGain.

A Comparative Study of Laryngeal Mask Airway and Air-Q Intubating Laryngeal Airway Using Parker Flex Tip Tube

Background: To facilitate tracheal intubation, intubating laryngeal mask airway(ILMA) was designed specifically. A relatively new supraglottic airway device, air-Q ILA is an alternative to ILMA to facilitate endotracheal intubation. Considering advantages of air-Q over ILMA are that the breathing tube of the device is shorter, wider and due to removable connector, a standard e Parker Flex Tip tracheal tube (product of Parker Medical Company) has a curved, centered, flexible and tapered distal tip that is designed to facilitate easy, rapid and non-traumatic intubation. It has double murphy eyes with an anterior curvature and a posterior opening bevel. It is designed so that the posterior bevel will decrease the incidence of the tube catching at the anterior or the lateral laryngeal structures during tracheal intubation.Subjects and Methods: This is a randomized, single-blind study. Total of 100 patients of either sex aged 18–60 years belonging to American Society of Anaesthesiologists (ASA) physical status I or II scheduled for elective surgery under general anesthesia with endotracheal intubation were included in the study and the patients with respiratory or pharyngeal pathology, mouth opening &lt; 2.5 cm, body mass index ≥35 kg/m2, pregnancy and anticipated difficult airway were excluded from the study. The duration of the study was one year. The ethical clearance was taken from the institutional ethical committee. Written informed consent from all participants was obtained for participation in the study. Results: A total of 100 patients were allocated for the study. The insertion of the airway device was successful in all the patients of group 1. So, 50 patients were analysed for intubation in group 1. Air-Q ILA could not be inserted and resulted in failure in two cases. Hence, 48 patients were analysed statistically for intubation in group 2. The two groups were comparable with respect to age, weight and sex distribution. The mean age of patients in group 1 was 40.00 ± 10.76 years and in group 2 it was 40.56 ± 11.0 years (P = 0.651). There were 30 females and 20 males both in group 1 and group 2 (P = 1.000). The mean weight of patients in group 1 was 60.34 ± 8.06 kg and in group 2 was 60.10 ± 10.05 kg (P = 0.924). Conclusion:The overall success rate using Parker Flex Tip tube was more with ILMA (99%) as compared to air-Q ILA (78%). It can be further suggested that Parker Flex Tip tube can be used as an alternative to silicone tube with ILMA, but more multicentre studies are required over larger populations to evaluate the utility of Parker Flex Tip tube with air-Q ILA.

A study to evaluate and compare intubating laryngeal mask airway and air-Q intubating laryngeal airway for intubation using Parker Flex Tip tube.

Background and Aims:Though manufacturer recommendations suggest use of specific endotracheal tube (ETT) with intubating laryngeal mask airway (ILMA) and air-Q intubating laryngeal airway (ILA), Parker Flex Tip tube introduced by J D Parker has certain advantages and is also cost-effective. This study was conducted to compare ILMA and air-Q ILA for intubation using Parker Flex Tip tube.Methods:Patients of either gender, aged 18–60 years, scheduled for elective surgery requiring endotracheal intubation were included in this study. In group A (n = 55), blind intubation was done through ILMA using Parker Flex Tip tube and in group B (n = 55), blind intubation was done through air-Q ILA using Parker Flex Tip tube. Success rate, number of attempts, ease and a total time of intubation were recorded.Results:Intubation was successful in 54 patients (98.2%) in group A and in 46 patients (85.2%) in group B (P = 0.026). Intubation was significantly easy with ILMA (P = 0.048). Manoeuvres for intubation were used in 10.9% patients in group A while it was used in 27.8% patients in group B. Significantly, more manoeuvres were required with air-Q ILA for intubation (P = 0.026). Number of attempts for ETT placement (P = 0.092), insertion time of ETT (TT) (P = 0.472) and total time taken for successful intubation (P = 0.526) were comparable in both the groups.Conclusion:The intubating laryngeal mask airway was superior to the air-Q intubating laryngeal airway for blind intubation using Parker Flex Tip tube.

Comparison of conventional with Parker flex-tip tracheal tube for intubation through air-Q intubating laryngeal airway

Background and Aims:The problem of difficult and failed intubation led to increased development of equipment for airway management. A number of supraglottic airways have now been developed to facilitate the passage of tracheal tubes. Conventional PVC tracheal tubes are recommended for intubation through the air-Q ILA. No study has compared different PVC tubes for blind intubation through air-Q ILA. Thus, we undertook this prospective, randomised, single blind study to compare two PVC tracheal tubes with different designs viz. conventional PVC tracheal tube (TT) and Parker flex-tip TT with regards to success rate, ease of intubation and total time required for successful intubation through air-Q ILA.Material and Methods:One hundred patients of either sex, aged 18–60 years, belonging to American Society of Anesthesiologists (ASA) physical status class I and II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included in the study. Blind intubation using conventional PVC TT and Parker flex-tip tube was done in group A (n = 50) and group B (n = 50), respectively.Results:The first attempt success rate in Parker flex-tip TT was significantly more as compared to conventional PVC TT (P = 0.002). Success rate of intubation was significantly more in Parker flex-tip TT as compared to conventional PVC TT (P = 0.004). The intubation was significantly easy in Parker flex-tip tube as compared to conventional PVC TT (P = 0.002). Total time of intubation was less in Parker flex-tip tube as compared to PVC TT (P = 0.043).Conclusion:Unique design of the Parker Flex-tip TT resulted in increase in success rate, first attempt success rate and ease of intubation in group B in present study.

Fibreoptic Orotracheal Intubation of Obese Patients Using Parker Flex-Tip vs. Standard Endotracheal Tube.

Advancement of the endotracheal tube through a fibreoptic scope can sometimes prove to be challenging in obese patients. The Parker Flex-Tip endotracheal tube was developed with a curved and tapered distal tip to facilitate easier placement in the trachea. This study examined the use of the Parker Flex-Tip tube as compared to standard endotracheal tubes in patients with a body mass index of 30 or greater. Sixty patients undergoing surgery requiring general anaesthesia were randomised into two groups. Using the fibreoptic scope, one group was intubated with the Parker Flex-Tip tube and the other group with a standard polyvinyl Portex tube. The time for intubation and the number of attempts required to place the endotracheal tube were measured and recorded. Using the Mann-Whitney U rank sum test, the median time needed for intubation with the two types of endotracheal tubes did not show a significant difference. The chi-square analyses were conducted for the number of attempts needed to place the endotracheal tubes, which also did not demonstrate any significant difference. Parker Flex-Tip endotracheal tube was not superior to the standard endotracheal tubes for fibreoptic intubation in obese patients.

A styletted tracheal tube with a posterior-facing bevel reduces epistaxis during nasal intubation: a randomized trial.

Epistaxis is a common complication of nasal intubation. Ease of insertion of the tracheal tube may be influenced by bevel orientation and tip bending. We examined ease of insertion and epistaxis with two tubes with different orientations and with or without a stylet to modify tip bending. Two hundred patients scheduled to undergo oral or maxillofacial surgery were randomized into four groups according to method of nasal intubation used after induction of anesthesia. In one group, a Portex(®) tracheal tube was inserted with bevel facing left (Portex Group). In the second group, a Parker Flex-Tip(®) tube (Parker Group) was inserted with the bevel facing posteriorly, and in the last two groups, a stylet bent at 60° anteriorly was used with the Portex tube (Stylet-Portex Group) or Parker tube (Stylet-Parker Group). When the tube advanced without resistance, insertion was defined as "smooth", and when resistance was encountered, insertion was defined as "impinged". Severity of epistaxis was evaluated as none, mild, moderate, or severe. Smooth insertion was observed in 60% of patients in the Portex Group; 80% in the Parker Group; 100% in the Stylet-Portex Group; and 100% in the Stylet-Parker Group. Epistaxis was found in 50%, 24%, 20%, and 4% of patients, respectively. The styletted tip (difference: 30%; 95% confidence interval [CI]: 20.3 to 38.5; P<0.0001) was found to improve ease of insertion. Both the posterior-facing bevel (difference: 21%; 95% CI: 9.0 to 32.1; P=0.0005) and stylet (difference: 25%; 95% CI: 13.1 to 35.9; P<0.0001) contributed significantly to absence of epistaxis. Using a styletted tracheal tube with a posterior-facing bevel improves ease of insertion through the nasopharynx and decreases the severity of epistaxis during nasal intubation. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000011327.

Parker Flex‐Tip or standard tracheal tube for percutaneous emergency airway access?

Percutaneous emergency airway access (PEAA) can be established utilising a scalpel, bougie and cuffed tracheal tube. The study compared the Parker Flex-Tip tracheal tube with a standard tracheal tube for PEAA in cadavers. We hypothesised that a standard tracheal tube would be more likely to advance over a bougie into the trachea during a PEAA procedure than a Parker Flex-Tip tracheal tube. Three anaesthetists performed a PEAA with a scalpel, bougie and cuffed tracheal tube, 12 times each. Recorded times included: loading the tracheal tube onto the bougie and advancing the tube over the bougie to the skin, advancing the tube through the skin into the trachea and completion of the whole procedure. Subjective opinion regarding the ease of tube insertion was recorded by visual analogue scoring. Subjective opinion, overall time and time to complete each component of the procedure were not significantly affected by the type of tube used. The mean time for three novice anaesthetists to complete PEAA on a cadaver was 37.5 (8.8) s, after 1 h of training. In two of the 12 cadavers, the cricothyroid membrane could not be palpated or located with the scalpel. The Parker Flex-Tip tube and a standard tracheal tube perform equally well during PEAA procedures on adult cadavers.

Advantage of Parker Flex-tip Tube™ in endotracheal intubation using AirwayScope™ videolaryngoscope

To the Editor: I read with interest a paper written by Suzuki et al. [1]. In that article, they evaluated the advantage of Parker Flextip Tube in endotracheal intubation using AirwayScope videolaryngoscope (AWS; Hoya, Tokyo, Japan) in patients without difficulty. I agree with the authors’ conclusion that the use of the Parker tube in combination with the AWS is an optional technique on some occasions. However, there is no evidence to the advantage of their means of inserting the blade tip of the AWS behind the epiglottis in patients with difficulty. Indeed, it is crucial to examine such an advantage only in patients with unsuccessful endotracheal intubation using the AWS at the first attempt [2]. Therefore, we must await additional studies to confirm the conclusion drawn by Suzuki et al. Acknowledgments This work was supported by departmental sources.

Performance of a Parker Flex-Tip tube® for intubation with the Pentax-AirwayScope®

Performance of a Parker Flex-Tip tube® for intubation with the Pentax-AirwayScope®

Parker Flex-Tip Tube® provides higher intubation success with the Pentax-AWS Airwayscope® despite the AWS tip being inserted into the vallecula

The Parker Flex-Tip(®) tube, in combination with the Pentax-Airwayscope(®) (AWS), is anecdotally reported to facilitate intubation when the AWS tip fails to be inserted behind the epiglottis. We examined whether the Parker tube facilitates intubation when the AWS tip is inserted into the vallecula. Forty patients were randomly assigned into either the standard or Parker tube group. Following general anesthesia induction, AWS intubation was attempted with the blade tip inserted into the vallecula. After obtaining an optimal laryngeal view, the tube was advanced toward the glottis. The laryngoscopist allowed additional adjustment of the blade tip direction when the first tube insertion failed because of involvement or folding of the epiglottis resulting from advancement of the tube. The primary outcome was defined as the success rate for intubation and secondary outcome as the time needed for tube placement. The Parker tube provided both a higher intubation success rate (17/20 vs. 4/20, P<0.01), and a faster intubation time (17±5 s vs. 25±4 s, P<0.01), than the standard tube. We conclude the use of the Parker tube in combination with the AWS is an optional technique allowing the laryngoscopist to obtain more reliable intubation success despite insertion of the AWS tip into the vallecula.

A Randomized Comparison of a Parker Endotracheal Tube and a Standard Tube Oriented 90&amp;#176; Counterclockwise

Purpose: During oral fiberoptic intubation, advancement of an endotracheal tube (ETT) into the trachea is occasionally impeded by laryngeal structures. The curved flex tip Parker ETT has been shown to improve the likelihood of successful advancement as opposed to a standard ETT that is advanced in neutral orientation. However, a Parker tube has not been compared to a standard ETT oriented 90° counterclockwise from the neutral position. We hypothesize that fiber-optically-guided advancement of an ETT into the trachea will be more successful when using a Parker tube than a 90° counterclockwise-oriented standard ETT. Methods: This unblinded, randomized controlled trial compares the rate of successful advancement of a fiberoptically-guided endotracheal tube into the trachea. Two groups of randomly assigned patients with non-difficult airways are compared: a Parker flex-tip tube (Parker Group; n = 57) versus a standard ETT oriented 90° counterclockwise (Standard Group; n = 58). Our primary outcome is the first pass success rate of advanceing the ETT into the trachea. Results: First pass success occurred in 48 of 57 (84%) patients in the Parker Group vs. 39 of 58 (67%) of patients in the Standard Group (p = 0.0497). Conclusion: When advancing an ETT over an oral fiberoptic scope and into the trachea, a Parker curved flex tip ETT is statistically more likely to be placed successfully on the first pass than is a standard ETT oriented 90° counterclockwise.

In reply: Comments on use of a Parker Flex-Tip tube® to facilitate intubation with the Pentax-AWS®

In reply: Comments on use of a Parker Flex-Tip tube® to facilitate intubation with the Pentax-AWS®

Comments on use of a Parker Flex-Tip tube® to facilitate intubation with the Pentax-AWS®

To the Editor: The recent article of Ohmura et al. [1] regarding use of a Parker Flex-Tip tube to facilitate intubation when the Pentax-AWS (AWS) fails to reach the larynx was of great interest to us. Although they provided a useful method to improve success rate of intubation with the AWS, there are several aspects that have to be clarified. In their case report, the PBlade tip of the AWS was not able to be advanced beneath the epiglottis but was inserted into the vallecula. The epiglottis was indirectly elevated, and the laryngeal exposure was approximately 80% of the glottic opening. Actually, the design of the AWS PBlade is to be inserted posterior to the epiglottis, directly elevating it out of the way (Miller-type approach) [2, 3]. Also, the target mark on the monitor is designated for a preformed, curved endotracheal tube (ETT) [4]. In this way, the curved ETT advanced from the guiding channel tends to travel forward for a short distance almost in line with and align with the glottis [2]. However, when the AWS PBlade is inserted into the vallecula (Macintosh-type approach), intubation often fails because of ETT impingement on the epiglottis [2]. According to our experience and the available literature, difficulty in inserting the PBlade tip into the posterior surface of the epiglottis really is a common troublesome problem during intubation with the AWS, particularly at patients with micrognathia, a short neck, or limited head and neck movement. In patients with simulated restricted neck mobility, this issue had resulted in multiple intubation attempts in 42% of patients [3]. It is easily corrected by partially withdrawing the device, and with a subsequent scooping movement of the PBlade, lifting the epiglottis, and advancing the ETT into the trachea. A second solution is to insert a bougie through the ETT and into the trachea and then railroad the ETT over the bougie via the glottis. In their mannequin study, the AWS PBlade was deliberately inserted into the vallecula (Macintosh-type approach). In this case, the epiglottis can indirectly be elevated by the AWS PBlade, and most of the glottic opening may be viewed on the monitor. This approach does not differ from the condition in which the AWS PBlade fails to reach the larynx; the latter occurs because the distance from the mouth to the larynx of the patient is longer than the designed length of the PBlade [4]. In this situation, the epiglottis cannot indirectly be left by the AWS PBlade, and the pendulous epiglottis may obstruct the laryngeal view and interfere with alignment of the ETT tip with the glottis. Based on the findings of this mannequin study, therefore, we believe it would be more appropriate to conclude that the use of the Flex-Tip tube allows for successful intubation when the AWS PBlade is inserted by a Macintosh-type approach. One of the most important features of the AWS that facilitates intubation is a target mark on the monitor, which indicates the direction of travel of the ETT as it advances from the guiding channel [5]. Before advancing the ETT, the glottis must be positioned at the center of the target mark. In panels b and d of fig. 1 of this article, however, the glottis seems to be at the left side of the target mark, rather than the center of the target mark. We would like to know whether a different orientation relationship of the An answer to this letter to the editor is available at doi: 10.1007/s00540-010-1057-4.

Parker Flex-Tip Tube® facilitates intubation when the Pentax-AWS® fails to reach the larynx

To the Editor: Pentax-AWS Airway Scope (AWS: Hoya, Tokyo), a new rigid, indirect videolaryngoscope with integrated tube guidance, has been successfully used in patients with both normal and difficult airways. In some case, however, the blade tip cannot be advanced beneath the epiglottis, even after multiple attempts [1], and the intubation frequently fails due to blade configuration [2]. Several authors proposed the use of tube introducer (elastic bougie) to solve the problem [3]. We propose the use of the Parker Flex-Tip Tube to facilitate intubation under this situation. Preoperative airway assessment of a 61-year-old man scheduled for general anesthesia indicated a risk of difficult intubation because of relatively small mandible, his thyromental distance being 4 cm. Since the patient did not have risk factors of difficult mask ventilation, he was anesthetized with propofol and rocuronium. After complete paralysis was confirmed with the peripheral nerve stimulator, laryngoscopy was performed with a Macintosh no. 4 blade, but only the epiglottis was visualized, and it was graded as Cormack‐Lehane grade 3b. We next used the AWS for the second intubation attempt. However, the tip was not able to be advanced beneath the epiglottis but inserted into the vallecula. The epiglottis was indirectly elevated, and the laryngeal exposure was approximately 80% of the glottic opening. We tried to insert the standard bevel tube (Phycon Tube, Fuji System, 7.5 mm ID, 10 mm OD) set in the channel, but the tube tip impinged onto the epiglottis, and intubation failed. Next, we used the Parker Flex-Tip Tube (Kobayashi Medical, 7.5 mm ID, 10 mm OD), and the tube was inserted smoothly into the glottis without trapping on the arytenoids. The Parker Flex-Tip Tube has a tapered, curved tip and has been shown to facilitate intubation with the Bullard laryngoscope [4] and fiberoptic bronchoscope [5]. The advantage of using the Parker tube in combination with the AWS has not been well evaluated. Figure 1 shows the two tubes, with the same outer diameter as those used in this case, protruding from the channel. We can see more space from the blade tip to the Parker tube than with the standard tube. It seems that this space allows the Parker tube to be advanced without impinging upon the epiglottis, and the tapered, curved tip glides on the posterior surface of the epiglottis to lead the

Parker Flex-Tip and Standard-Tip Endotracheal Tubes: A Comparison During Nasotracheal Intubation

The placement of endotracheal tubes in the airway, particularly through the nose, can cause trauma. Their design might be an important etiologic factor, but they have changed little since their introduction. Recently Parker Medical (Bridgewater, Conn) introduced the Parker Flex-Tip (PFT) tube, suggesting that it causes less trauma. This study aimed to compare the PFT endotracheal tube to a side-beveled, standard-tip endotracheal tube (ETT) for nasotracheal intubation (Figures 1 and 2). Forty consecutive oral surgery patients requiring nasotracheal intubation were randomized to receive either a standard ETT or the PFT tube. Intubations were recorded using a fiber-optic camera positioned proximal to the Murphy eye of the tube. This allowed visualization of the path and action of the tube tip as it traversed the nasal, pharyngeal, laryngeal, and tracheal airway regions. Video recordings made during intubation and extubation were evaluated for bleeding, trauma, and intubation time. Both bleeding and trauma were recorded using a visual analogue scale (VAS) and by 3 different evaluators. The PFT received significantly better VAS values than the standard tubes from all 3 raters (P < 0.05) in both the extent of trauma and bleeding. Since the intubations were purposefully conducted slowly for photographic reasons, neither tube displayed a time advantage. This study suggests that the PFT tube design may be safer by causing less trauma and bleeding than standard tube designs for nasotracheal intubation.

The Parker Flex-Tip™ tracheal tube makes endotracheal intubation with the Bullard laryngoscope easier and faster

The Bullard laryngoscope can be useful in management of difficult airway. When the endotracheal tube is advanced over the original Bullard laryngoscope stylet, the endotracheal tube sometimes makes contact with structures around the vocal cords, especially the right arytenoids. A similar problem also occurs with flexible fibreoptic intubation and it has been shown that use of the Parker Flex-Tip tube usually resolves the problem. In this study we tested our hypothesis that use of the Parker Flex-Tip tube might improve endotracheal tube passage with the Bullard laryngoscope. Forty patients scheduled for elective anaesthesia were randomly assigned into group ST (standard tube) or Group PT (Parker Flex-Tip tube). The time taken to achieve successful endotracheal tube placement after obtaining the best laryngeal view, the number of attempts at intubation and the incidences of successful intubation at first attempt and of re-direction of the Bullard laryngoscope during intubation were recorded. Unpaired t-test and chi2-test were employed and P < 0.05 was considered significant. Use of the Parker Flex-Tip tube reduced the time required for successful endotracheal tube placement after the best laryngeal view was obtained from 14 +/- 6 to 6 +/- 2 s (P < 0.01). It also reduced the incidence of requirement for re-direction of the Bullard laryngoscope during intubation from 10/19 to 1/19 (P < 0.01). The incidence of successful intubation at the first attempt (18/19 vs. 15/19) was higher in the PT group but the difference was not statistically significant. During intubation with the Bullard laryngoscope, use of the Parker Flex-Tip tube is associated with more rapid success and a lower incidence of re-direction of the Bullard laryngoscope during endotracheal intubation when compared to a standard endotracheal tube.

Flexible, tapered-tip tube facilitates conventional orotracheal intubation by novice intubators

Orotracheal intubation is the standard technique for airway management, but several untoward airway complications are possible with this method. To avoid airway trauma caused by the tube tip during intubation, the Parker Flex-Tip tube (PFT), which has a flexible, tapered tip, was developed. It has been reported that the PFT facilitates fiberoptic orotracheal intubation and introducer-guided tracheal intubation. In this study, we compared the PFT to a standard endotracheal tube (SET), regarding the time of intubation during conventional orotracheal intubation and the incidence of postoperative sore throat and hoarseness. One hundred and thirty-four patients scheduled for elective anesthesia using orotracheal intubation were randomized to either the PFT or SET and 132 completed the study. The intubators were classified into three groups: staff anesthesiologists, inexperienced anesthesiologists, and anesthesia trainees. The tube was selected by another anesthesiologist and the time required for intubation was measured. PFT did not shorten the time required for intubation and did not reduce the incidence of sore throat and hoarseness. However, a detailed analysis revealed that the PFT decreased the time required for intubation in the anesthesia trainee group. The PFT may help novice intubators to conduct a smooth intubation.

A less-traumatic way of light-guided intubation with Parker Flex-Tip tube

A less-traumatic way of light-guided intubation with Parker Flex-Tip tube