Anesth Analg 2005;100:902-903
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000146660.14354.E9
LETTER TO THE EDITOR
Use of the CobraPLATM for Percutaneous Cricothyroidotomy and Tracheostomy
Felice Agro, MD,
Massimiliano Carassiti, MD, and
Caterina Magnani, MD
Department of Anesthesia; University School of Medicine-Campus Bio-Medico; Rome, Italy; F.Agro{at}unicampus.it
In Response:
Dr. Cook raises two reservations regarding the use of CobraPLATM in anesthetized patients. First, he suggests that either the Proseal LMATM (PLMA) or the Laryngeal tube sondaTM offer better alternatives for fulfilling the requirements of a supraglottic airway when used for percutaneous tracheostomy, including aspiration protection, but he offers no data or scientific literature to support this statement. We would caution that no supraglottic airway be used for this procedure if aspiration risk exists, as cases of aspiration have occurred even with use of the PLMATM (1,2). Furthermore, while the fiberoptic view through the PLMATM may be quite good, it is likewise with the CobraPLATM (3).
The CobraPLATM more easily accommodates passage of a large adult bronchoscope for viewing the tracheostomy procedure itself.
Dr. Cook further cautions against extending the use of the CobraPLATM given his experience of two episodes of aspiration during approximately 60 elective uses. We cannot fathom how this remarkably high incidence of aspiration could occur in elective fasted patients with any device used for airway management, including a face mask, as long as patients were not at increased risk for regurgitation (symptomatic hiatal hernia, diabetic with gastroparesis, etc.) and procedures that increase the risk of this complication (laparoscopy, etc.) were avoided. Dr. Cook provides no details regarding his two cases, but we have reported use of the CobraPLATM in 138 elective patients (4,5) without any regurgitation or aspiration occurring. Our continuing use of the CobraPLATM for percutaneous tracheostomy now includes six cases without this complication. Furthermore, our departmental experience with use of the CobraPLATM in over 200 elective surgical cases has been done without any significant complications of any kind.
Finally, we would agree that the safety profile of any new device needs to be established with appropriate scientific studies.
References
- Koay CK. A case of aspiration using the ProSeal LMA. Anaesth Intensive Care 2003;31:123.[Medline]
- Brimacombe CJ Jr, Keller C. Aspiration of gastric contents during use of a ProSeal laryngeal mask airway secondary to unintended foldover malposition. Anesth Analg 2002;94:1193–4.
- Akca O, Anapura W, Sengupta P, et al. The new perilaryngeal airway (CobraPLA TM) is as efficient as the laryngeal mask airway (LMA TM) but provides better airway sealing pressures. Anesth Analg 2004;99:272–8.[Abstract/Free Full Text]
- Agro F, Barzoi G, Carassiti M, Galli B. Getting the tube in the oesophagus and oxygen in the trachea: preliminary results with the new supraglottic device (CobraPLA TM) in 28 anaesthetized patients. Anaesthesia 2003;58:920–1.[Web of Science][Medline]
- Agro F, Barzoi G, Galli B. The CobraPLA TM in 110 anaesthetized and paralysed patients: which size to choose? Br J Anaesth 2004;92:777–8.[Free Full Text]
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