Types Of Endotracheal Tubes Research Articles

Effect of different patient positions on endotracheal tube cuff pressure in patients undergoing urological procedures: a prospective study.

The endotracheal tube (ETT) contains a cuff that is placed in the trachea to prevent gas leakage and aspiration of secretions and gastric contents. However, patient positioning after intubation may cause ETT displacement and changes in cuff pressure. Evaluate the effect of different patient positions on ETT cuff pressure in patients undergoing urological procedures in supine, prone, lateral flank, and lithotomy positions. Prospective and observational study. A university hospital in Turkey. Patients who underwent surgeries under general anesthesia in different patient positions were involved. After intubation (T0), the cuff pressure was checked with a manometer and adjusted to 25 cmH2O and continuously monitored. The cuff pressure was checked before (T1) and after achieving the final position (T2) and then at 5, (T3), 10, (T4), 15 minutes (T5) of the position, at the end of the procedure (T6) and before extubation (T7). At postoperative 2nd and 12th hours, the patients were interviewed for sore throat, hoarseness, and cough. The effect of different patient positions on the ETT cuff pressure. 200 patients. The cuff pressure increased significantly at T2 in the lithotomy, lateral flank, and prone groups (P<.001 each). The highest increase in cuff pressure occurred in the prone group (34.3 [7.5] cmH2O). Over time, the cuff pressure decreased in all groups during surgery. Postoperative complications at the 2nd postoperative hour were similar in all groups; however, the mean cuff pressure was significantly higher in the patients with postoperative sore throat or cough (sore throat: P=.003; cough: P=.047). ETT cuff pressures are affected by different patient positioning; therefore, regular recording and adjustment of cuff pressure are necessary for patient safety. We used ETT of a single manufacturer. Therefore, our findings may not be applicable to other types of ETT.

Association of DLT versus SLT with postoperative pneumonia during esophagectomy in China: a retrospective comparison study

BackgroundDouble lumen tube (DLT) and single lumen tube (SLT) are two common endotracheal tube (ETT) types in esophageal cancer surgery. Evidence of the relationship between two ETT types and postoperative pneumonia (PP) remains unclear. We aimed to determine the association between two types of ETT (DLT and SLT) and PP and assess the perioperative risk-related parameters that affect PP.MethodsThis study included 680 patients who underwent esophageal cancer surgery from January 01, 2010 through December 31, 2020. The primary outcome was PP, and the secondary outcome was perioperative risk-related parameters that affect PP. The independent variable was the type of ETT: DLT or SLT. The dependent variable was PP. To determine the relationship between variables and PP, univariate and multivariate analyses were performed. The covariables included baseline demographic characteristics, comorbidity disease, neoadjuvant chemotherapy, tumor location, laboratory parameters, intraoperative related variables.ResultsIn all patients, the incidence of postoperative pneumonia in esophagectomy was 32.77% (36.90% in DLT group and 26.38% in SLT group). After adjusting for potential risk factors, we found that using an SLT in esophagectomy was associated with lower risk of postoperative pneumonia compared to using a DLT (Odd ratio = 0.41, 95% confidence interval (CI): 0.22, 0.77, p = 0.0057). Besides DLT, smoking history, combined intravenous and inhalation anesthesia (CIIA) and vasoactive drug use were all significant and independent risk factors for postoperative pneumonia in esophagectomy. These results remained stable and reliable after subgroup analysis.ConclusionsDuring esophagectomy, there is significant association between the type of ETT (DLT or SLT) and PP. Patients who were intubated with a single lumen tube may have a lower rate of postoperative pneumonia than those who were intubated with a double lumen tube. This finding requires verification in follow-up studies.

Adverse event using Medtronic NIM™ EMG endotracheal tube on a patient receiving anesthesia for hemithyroidectomy: a case report

BackgroundThe neural integrity monitor (NIM) electromyogram (EMG) endotracheal (ET) tube is a widely used device to monitor neural response through muscle activity. It is helpful in surgical procedures with high risk of damaging delicate structures in the head and neck. This case provides a thorough analysis of an adverse event that was encountered in the operating room, which others can hopefully learn from.Case presentationWe are reporting a case in which a patient undergoing hemithyroidectomy had experienced an adverse event using the Medtronic NIM™ EMG endotracheal tube. After successful induction and intubation, confirming the proper positioning of the electrode wires was necessary before the incision could be made. Upon reexamination, the patient suddenly became difficult to ventilate with increased peak airway pressure, decreased tidal volume, and end tidal CO2. This episode lasted approximately 15 min and the patient’s condition remained stable despite low tidal volumes. The problem was unexpectedly resolved upon deflation of the cuff of the ET tube.ConclusionsThere are several similar reports of these endotracheal tubes causing obstruction, especially those in which overinflation of the cuff caused cuff herniation and blockage of the Murphy eye and the bevel. It is currently believed that the design of this tube allowed for the obstruction to occur. The patient’s short body habitus may have also been a small contributing factor. The distance that the electrodes must sit within the vocal cords to the tip of the bevel is longer in this type of ET tube compared with a standard ET tube. The distance from the true vocal cords to where the cuff sits in the trachea is also greater in this model NIM EMG tube. There was no confirmation of the exact obstructive process that took place, however, confirming the tube and cuff positioning would have been optimal.

Experimental Assessment of Cuff Pressures on the Walls of a Trachea-Like Model Using Force Sensing Resistors: Insights for Patient Management in Intensive Care Unit Settings.

The COVID-19 outbreak has increased the incidence of tracheal lesions in patients who underwent invasive mechanical ventilation. We measured the pressure exerted by the cuff on the walls of a test bench mimicking the laryngotracheal tract. The test bench was designed to acquire the pressure exerted by endotracheal tube cuffs inflated inside an artificial model of a human trachea. The experimental protocol consisted of measuring pressure values before and after applying a maneuver on two types of endotracheal tubes placed in two mock-ups resembling two different sized tracheal tracts. Increasing pressure values were used to inflate the cuff and the pressures were recorded in two different body positions. The recorded pressure increased proportionally to the input pressure. Moreover, the pressure values measured when using the non-armored (NA) tube were usually higher than those recorded when using the armored (A) tube. A periodic check of the cuff pressure upon changing the body position and/or when performing maneuvers on the tube appears to be necessary to prevent a pressure increase on the tracheal wall. In addition, in our model, the cuff of the A tube gave a more stable output pressure on the tracheal wall than that of the NA tube.

Comparison between Polyvinyl Chloride and Flexometallic Endotracheal Tube for Blind Tracheal Intubation through I-gel: A Randomised Clinical Study

Introduction: I-gel is the most commonly used, secondgeneration supraglottic airway device, which plays an important role in modern anaesthesia practice as a rescue device in difficult as well as failed intubation situations and resuscitations. Now-a-days, it is gaining popularity as a conduit to facilitate endotracheal intubation. No Endotracheal Tube (ETT) is designed specifically for intubation through I-gel. The ETT used for routine tracheal intubation are standard Polyvinyl Chloride (PVC) ETT and Flexometalic ETT. Aim: To compare the two different types of ETTs i.e. standard PVC ETT and Flexometatlic ETT for blind tracheal intubation through I-gel. Materials and Methods: The present study was a singleblinded, randomised clinical trial in which 120 patients were randomly allocated into two groups on the basis of the ETT used for intubation through I-gel. In Group P blind tracheal intubation was done using PVC ETT, and in Group F blind tracheal intubation was done using Flexometatlic ETT through I-gel. Time taken for successful intubation, number of successful intubations, ease of intubation, number of attempts,manoeuvers used, and complications were recorded. Results: The mean time taken for successful intubation in Group P was 22.31±3.771 sec and in Group F was 26.51±4.408 sec (p&lt;0.05). Intubation was significantly easy (26/60 vs 13/60) with PVC ETT (p=0.011). More patients were successfully intubated with PVC ETT than Flexometalic ETT (48/60 vs 36/60; p=0.017). Conclusion: PVC ETT is a better choice for blind tracheal intubation through I-gel as compared to flexometallic ETT.

Cuffed vs Uncuffed Endotracheal Tubes for Pediatric Patients: A Review

The use of uncuffed endotracheal tubes (ETT) in patients younger than 8 years old has been in practice for the last 60 years. In the last decade, there has been a change in clinical practice with a transition to cuffed ETT use, and there continues to be debate between cuffed vs uncuffed ETT use. This narrative review article aims to review the current literature on the topic and highlight some key points in the argument of cuffed vs uncuffed ETT use in pediatric patients. Cuffed ETTs are increasingly being used with several studies over the last 20 years demonstrating its benefits. Studies have claimed cuffed ETT has a clinical, environmental, and economical benefit over uncuffed ETT. Despite shortcomings of various studies and no definitive conclusion of a superior type of endotracheal tube, cuffed ETTs are here to stay in the world of anesthesia.

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.

Safe Use of Flammable Endotracheal Tubes During Anesthesia for Laryngeal Laser Surgery-Report of 1024 Cases and a Brief Literature Review.

One of the major concerns in laryngeal laser surgery is the risk of airway fire. The introduction ofwrapped tubes and metal tubes has reduced the fire hazards. However, these tubes are expensive and do not provide convenient access to the surgical field. There are few laboratory studies addressing the resistance of polyvinylchloride tubes against ignition in the given circumstances. Nevertheless, its safety should be approved in clinical practices. This retrospective studyevaluated the airway management on 1024 patients undergoing laryngeal laser surgery. The data collection included the information about the type of endotracheal tube (ETT), mode of ventilation, and airway hazards (e.g., tube ignition). Polyvinylchloride tubes and conventional positive pressure ventilation was applied for most of the patients (84.1%). The tube cuff was pierced with laser beam in 22 cases (2.5%). However, there was no case of ETT ignition or airway fire. Polyvinylchloride tubes can be safely used in this subset of surgeries pending meticulous attention to the safety recommendations.

I-Gel as an intubation conduit: Comparison of three different types of endotracheal tubes.

Background and Aims:I-Gel®, a novel SAD has been introduced as a ventilating device but has widely gained popularity as conduit for intubation. Unlike intubating laryngeal mask airway (ILMA), I-Gel® does not have an endotracheal tube specially designed for it. Hence the aim of this study was to compare the rate of successful intubation via I-Gel® using three different types of endotracheal tubes.Methods:We randomised 75 American Society of Anesthesiologists (ASA) physical status I and II patients, between the age group 18-60 years of either sex undergoing elective surgery under general anaesthesia into three groups on the basis of endotracheal tube (ETT), used for intubation via I-Gel®: Group P (Polyvinyl chloride ETT), Group I (Intubating laryngeal mask airway ETT), Group F (flexometallic ETT). After following the standard induction protocol, appropriate size I Gel® was inserted in all patients. Thereafter group specific ETT was inserted via I-Gel®. We recorded and compared the time taken for successful intubation, the success rate, number of attempts taken, manoeuvres used, and complications among three different types of ETT. Quantitative variables were compared using Kruskal Wallis test and the qualitative variables were compared using Chi-square test.Results:The time taken for successful intubation was least in group P (10.51 ± 3.82 seconds). Group P also had the highest first attempt (68%) and overall rate of successful intubation (88%).Conclusion:PVC ETT had highest first attempt success rate and required minimum time for endotracheal intubation via I-Gel® when compared to ILMA ETT and Flexible ETT.

Comparison of polyvinyl chloride, curved reinforced, and straight reinforced endotracheal tubes for tracheal intubation through Airtraq™ laryngoscope in anesthetized patients.

Background and Aims:The Airtraq™ video laryngoscope facilitates tracheal intubations in patients with difficult airway or cervical spine immobilization. However, curved reinforced tracheal tube and straight reinforced tracheal tubes are useful where neck of the patient is likely to be moved or flexed or if patient is in prone position, wherein nonreinforced endotracheal tube (ETT) might get kinked and/or compressed. We compared intubation success rate of curved and straight reinforced tracheal tubes with polyvinyl chloride (PVC) tracheal tube using Airtaq™ laryngoscope in paralyzed and anesthetized patients.Material and Methods:Totally, 120 patients underwent random allocation to one of the three groups using computer-generated randomization table. Patients were intubated with appropriate size and type of ETT using Airtraq™ after obtaining optimal glottis view. Experienced anesthesiologist performed endotracheal intubation and unblinded observer noted down success and ease of intubation.Results:Patients intubated with PVC tube (100%) had higher rates of successful intubation and shorter intubation time (4 s), in comparison to intubation with curved reinforced (92.5%) and straight reinforced tubes (SRTs) (85%) using Airtraq™ laryngoscope (AL). However, there was no statistical difference in the incidence of airway trauma among all the three groups.Conclusions:PVC tracheal tube is significantly superior to both curved and SRTs for intubation using AL.

Efficacy of a type of endotracheal tube of extended with terminal swelling and resistance bending pressure for airway management during mechanical ventilation in children in prone position

Objective To evaluate the efficacy of a type of endotracheal tube of extended with terminal swelling and resistance bending pressure for airway management during mechanical ventilation in children in prone position. Methods Sixty pediatric patients with cerebral palsy of both sexes, aged 3-7 yr, weighing 11-23 kg, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elective selective functional posterior rhizotomy, were randomly allocated into 2 groups (n=30 each) using a random number table: endotracheal tube of extended with terminal swelling and resistance bending pressure group (group E) and reinforced tracheal tube group (group C). After induction of anesthesia, the type of endotracheal tube of extended with terminal swelling and resistance bending pressure was inserted in group E, and the reinforced endotracheal tube was inserted in group C. The tidal volume, minute ventilation, dynamic lung compliance, arterial oxygen saturation and end-tidal pressure of carbon dioxide in pressure-controlled ventilation mode were recorded in the two groups.Tube shedding caused by using of the extended tube was recorded during operation.Blood samples were collected from the femoral artery for blood gas analysis. Results Compared with group C, the tidal volume and minute ventilation were significantly increased (P 0.05). Compared with the value before anesthesia, no significant change was found in pH value, arterial oxygen partial pressure and partial pressure of arterial carbon dioxide at the end of operation in the two groups (P>0.05). In group C, the extended tube was used in 3 patients, and among the 3 cases, one patient developed tube shedding which was treated immediately. Conclusion The type of endotracheal tube of extended with terminal swelling and resistance bending pressure provides better efficacy than the reinforced endotracheal tube when used for airway management during mechanical ventilation in children in prone position. Key words: Intubation, intratracheal; Respiration, artificial; Prone position; Child

Facilitating Endotracheal Intubation in Difficult Cases Using an External Magnet

Difficult airway is conventionally defined as a medical scenario in which a trained examiner faces difficulty in either facemask ventilation or tracheal intubation (1). Unlike difficult intubation, the incidence of difficult mask ventilation in adults is considerable (2, 3). Anesthesiologists and those who practice intubation should be familiar with the management of airway and be able to recognize and identify potentially difficult airways including congenital craniofacial deformities with micrognathia (e.g. Pier Robin, Treacher Collins, Goldenhar's, and Crouzon's syndromes) and metabolic diseases causing the deposition of accumulated by-products (e.g., Hurler's, Morquio's, and Beckwith-Wiedemann syndromes). Cormack and Lehane grades 3 and 4 at laryngoscopy are an indication for advanced techniques for intubation. Laryngeal mask airway (LMA) and fiberscope with a directable tip are useful and important modalities in handling difficult airway and intubation (5). Even normal pediatric airway could become critical due to the anatomical and physiological differences between pediatric and adult airway; this particularly becomes a concern in infants, i.e. children younger than one year old. This hazard is augmented in the presence of congenital or acquired difficulties affecting airway. Consequently, proper preoperative assessment is considered as the cornerstone of pediatric difficult airway management. Every anesthetic plan should be tailored according to patients considering the scenario and also the expertise of the practitioner. Opting for spontaneous respiration maintenance and intervening in a step-wise manner are strongly suggested (6) . Multiple airway devices have been and are developed that all of which can be placed under direct vision or blindly; most of these devices consistently both provide and maintain safe oxygenation and ventilation. Furthermore, a wide range of ancillary devices have also been introduced to be of assistance in the management of difficult airway; most of them are available in varied sizes suitable for use in children and incorporate a variety of different types of endotracheal tubes, supraglottic devices, fiber-optic, video, optical, and mechanical technologies. Some of these devices (e.g. video laryngoscope) are expensive and not suitable for developing countries with limited financial reserve; some others need high levels of experiences or learning courses which is not possible for anesthesiologist that are not working in university hospitals or are less experienced. Some of these devices cannot be used in small children or neonates. Therefore, we were encouraged to look for a device that is easy to use and carry, inexpensive, small in size, and available in all sizes for children, and also does not need special training.

A More Clinically Relevant Model of Ventilator-associated Pneumonia?

A More Clinically Relevant Model of Ventilator-associated Pneumonia?

JDSA Journal Abstracts

JDSA Journal Abstracts

Evaluation of three adjusting manoeuvres and type of endotracheal tube in the success of air-Q™ aided tracheal intubation

Background: The present study observed whether the use of three different adjusting manoeuvres and use of an armoured tracheal tube would increase the success rate of tracheal intubation, aided by the air-Q™ intubating laryngeal airway (air-Q ™ ILA). Method: Fifty American Society of Anesthesiologists (ASA) I and II patients undergoing elective surgical procedures were randomly assigned to two groups. In the endotracheal tube (ETT) group, standard ETT was used, while in the armoured ETT (AETT) group, tracheal intubation was performed using AETT. After a uniform premedication, induction and relaxation technique, an appropriate sized air-Q ™ ILA with ETT in-situ, was placed. After good ventilation, a flexible fibrescope was passed down the ETT, and the percentage of glottic opening (POGO) was documented. Subsequently, three adjusting manoeuvres were applied in sequence. These included firstly, backward pressure over the larynx; secondly, head extension; and lastly, neck flexion. After noting the POGO score with each adjusting manoeuvre, the incidence of successful intubation was noted, with and without manoeuvres. Results: The best POGO score (84%) was observed with the application of backward pressure. Successful tracheal intubation was achieved in 56-60% of patients without the use of any manoeuvres, using either type of tracheal tube. For the rest, tracheal intubation was achieved using backward pressure, except in one patient from the ETT group. The incidence of successful tracheal intubation was nearly identical with either type of ETT. Conclusion: Successful tracheal intubation can be achieved in 96% of cases using adjusting manoeuvres. The nature of the tracheal tubes did not influence the success rate.

Comparing cuff pressure changes in two types of endotracheal tube

Background Since medical devices from different manufacturers with various qualities may affect on outcome of interventions, studies regarding the correctness of them in terms of material and function have always been a major topic. Purpose This clinical trial was conducted to compare cuff pressure changes in two endotracheal tubes (ETT) in contact with nitrous oxide gas, manufactured in Iran and Malaysia. Methods 50 patients having elective surgery in Loghman Hakim Hospital and categorized in classes 1 and 2 according to American Society of Anesthesiology (ASA І, П) were randomly divided into 2 groups (27 and 23 subjects). In the first group with 27 subjects, Iranian tubes and in the other, Malasian ones were used. ETT cuffs were filled with air via minimal leak method and cuff pressures were measured by a cuff pressure indicator (VBM). It was connected to a pilot cuff until the end of anesthesia. Meanwhile, nitrous oxide 50% was prescribed for patients during anesthesia and the pressure was recorded every 20 minutes until 120 minutes of anesthesia. Results Mean and standard deviation of pressures in the cuffs of Iranian tubes before nitrous oxide administration were 96.43 and 8.23 respectively. The corresponding figures for pressures in Malaysian tubes were 17.32 and 97.4, which showed a significant difference (t=2.585, P=0.015). The standard deviation of Iranian tubes was significantly greater than Malysian ones (F=38.633, P<0.001). Conclusion It can be concluded that mean base pressures in the 2 types of tubes have no difference. This denotes that, at the beginning, there is no significant difference and the cuffs of Iranian tubes in spite of being filled with air like Malaysian ones show higher pressure difference. Mean base pressures of cuffs at different times indicate significant difference two by two. Keywords: Cuff pressure of endotracheal tube, Nitrous oxide gas.

Intubación traqueal guiada por fibrobroncoscopio en pacientes con vía aérea difícil. Factores predictores del resultado

Tracheal intubation (TI) guided by fibrobronchoscopy (FB) is one of the essential techniques in the approach to the difficult airway (DAW). Few works have been published on the possible causes of TI failure with this procedure. This study aims to discover which factors could predict TI failure with FB. An observational and retrospective study in which the last 122 consecutive TIs guided by FB (between January 2000 and April 2008) performed by our group were included. A multivariate analysis of the factors that could influence in the outcome was conducted: cause of the DAW, TI pathway, type of endotracheal tube, elective or urgent indication of the procedure, sedation level and experience of the bronchoscopist. Tracheal intubation in individuals who are going to undergo surgical interventions accounts for 92.6% of the total. The most frequent indications of TI by FB were: limitation of neck movement (60 cases), airway stenosis (24), increase of soft tissues (13), narrow oral aperture (9), airway compression (6), and vocal cord paralysis (6). In 10 (8.2%) cases, TI by FB was not possible. The variables that best predicted IT failure in the multivariate analysis were profound sedation/ general anesthesia (OR = 12.2; 95% CI, 1.8-84; p = 0.01) and limited experience of the bronchoscopist (OR = 25.3; 95% CI, 3.5-181.8; p = 0.001). TI guided by FB performed by bronchoscopist is successful in more than 90% of the cases with DAW. The skill and experience of the bronchoscopist is one of the primary determining factors of success of the procedure. Profound sedation may condition TI guided by FB failure.

Survey of neonatal respiratory support strategies

To survey current practice regarding neonatal respiratory support strategies to determine whether it reflected evidence from randomised trials. A questionnaire (in Supplementary Material online) survey of all U.K. neonatal units was undertaken to determine what modes of ventilation, types of endotracheal tube, lung function monitoring and oxygen saturation levels were used. There was an 80% response rate. Most (73%) units used in prematurely born infants (in the first 24 h) the intermittent positive pressure ventilation, and other respiratory modes included: CPAP (2%), triggered ventilation with or without volume guarantee (22%) and high frequency oscillation (2%). Only 15% of units used assist control mode for weaning; the preferred weaning mode was synchronous intermittent mandatory ventilation (73%). Few units used shouldered endotracheal tubes (3%) or lung function measurements (25%) to aid choice of ventilator settings. Oxygen saturation levels from 80% to 98% were used, levels greater or equal to 95% were used by 11% of units for infants with acute respiratory disease but by 34% of units for BPD infants (p < 0.001). Many practitioners do not base their choice of neonatal respiratory support strategies on the results of large randomised trials; more effective methods are required to ensure evidence-based practice.

Post-thyroidectomy sore throat following endotracheal intubation.

Sore throat is not an uncommon complaint following general anaesthesia (GA) with endotracheal intubation. It has been a source of considerable discomfort particularly in those patients who had thyroid surgery. Driven by the increased number of patients with post-intubation sore throat following thyroid surgery, the aim of the present study was to evaluate the contributing factors of sore throat in patients who had thyroid surgery under general anaesthesia. A total of 57 consecutive patients who had thyroid surgery from November 1998 to April 1999 was included in this prospective study. Factors such as intubation time, number of intubation attempts, size and type of endotracheal tube (ETT) used, gender and age were recorded. The nature and extent of the surgical procedures were also studied. Postoperative symptoms were assessed by questionnaire on the day after surgery and the different parameters were compared and analysed. The incidence of post-intubation sore throat following thyroid surgery was documented in 39 (68.4%) patients. Twenty-seven (47.4%) patients had a mild complaint of sore throat, which resolved after the third day. The data from the present study show that the size of ETT and extent of surgical procedure were significant contributing factors affecting the postoperative recovery. The outcome of the present study demonstrated a substantial increased incidence of sore throat after thyroid surgery under GA. Postoperative sore throat following thyroid surgery under GA may be caused by multiple contributing factors. Nonetheless effort and care should be taken during endotracheal intubation and surgery to reduce this unpleasant complaint arising mainly from pharyngeal irritation or trauma.

Use of the Endotrol Endotracheal Tube and a Light Wand for Blind Nasotracheal Intubation

Department of AnesthesiologyFukushima Medical University School of MedicineFukushima 960–1295, Japanken@cc.fmu.ac.jpIn Reply:—We thank Dr. Asai for his interest in our report. It does appear that the use of the Endotrol tube with the Trachlight accomplishes the same result as the modification we described. However, because our approach can be used with many different types of endotracheal tubes, it may be more generally applicable.