Anesth Analg 2007;104:1313
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000260462.74198.68
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
Prevention of Aspiration of Nasopharyngeal Airway
Dr Rajesh Mahajan,
Dr Sushil Kumar, and
Dr Rahul Gupta
Assistant Professor, Department of Anaesthesia ASCOMS, Jammu, Jammu & Kashmir, India, drmahajanr{at}yahoo.com, drmahajanr{at}rediffmail.com (Mahajan)
Senior Resident; Department of Anaesthesia (Kumar)
Senior Resident; Department of Hepatology; PGIMER, Chandigarh, India (Gupta)
To the Editor:
We have few points to add to the recent report by Tokoyama et al. (1) of airway obstruction caused by dislodgement of a size 6 Portex nasal airway. Although a safety-pin inserted at right angles through the proximal end of airway may prevent dislodgement (2), this hinders pharyngeal suctioning and application of T-piece for oxygen administration through the nasopharyngeal airway in a patient who cannot tolerate a face mask. To avoid these drawbacks we employ a modification of a nasopharyngeal airway similar to that proposed by Beattie (3), wherein a 15-mm endotracheal tube connector/adaptor is inserted into the proximal flared end of the nasopharyngeal airway (Fig. 1). A one-size larger tracheal tube connector (i.e., size 7 mm ID tracheal tube connector for size 6 mm nasal airway and size 8 mm ID tracheal tube connector for size 7 mm nasal airway) can be easily and snugly fitted into the proximal end of the nasopharyngeal airway. This adaptor has flanges that extend greater than the flange of nasopharyngeal airway on either side and provide an additional margin of safety over the flange of nasopharyngeal airway (Fig. 1). As an additional safeguard we also encircle 1 cm wide elastopore tape at the proximal end of the nasopharyngeal airway and secure it to the external nose in the same way as a nasotracheal tube is secured. These two measures both prevent caudal migration of even the smallest size nasopharyngeal airway and allow both pharyngeal suctioning and oxygen administration via a T-piece to occur.
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Figure 1. Size 7 nasopharyngeal airways fitted with size 8 tracheal tube adaptor, respectively. One can easily perceive the increased margin of safety over the flange of nasopharyngeal airway provided by use of the flanged adaptors against caudal migration.
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REFERENCES
- Tokoyama T, Yamashita K, Manabe M. Airway obstruction caused by nasal airway. Anesth Analg 2006;103:508–9.[Free Full Text]
- Mobbs PA. Retained nasopharyngeal airway. Anaesthesia 1989;44:447.[ISI][Medline]
- Beattie C. The modified nasal trumpet maneuver Anesth Analg 2002;94:467–9.[Abstract/Free Full Text]
