| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Department of Anesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
To the Editor:
The recent article by Panni and Corn (1) demonstrated that a disposable scavenging hood placed over a pediatric patient’s head with a suction applied greatly reduced the ambient contamination of anesthetic gases. The source of the contamination was the leaking gas from a loose fitting uncuffed endotracheal tube. While I strongly agree with Panni and Corn that we should strive to decrease the pollution of the operating room with potentially harmful agents, I disagree with their solution. Rather then spending money on yet another consumable that may prevent quick access to the patient’s head should the endotracheal tube become dislodged, I have a simpler solution. Namely, use cuffed endotracheal tubes for all pediatric cases. Khine et al (2) have shown that in children under age 8 years of age cuffed tubes did not lead to a higher incidence of croup, and required reintubation to switch to a different tube only 1% of the time versus 23% for the uncuffed tubes. In ICU pediatric patients, cuffed endotracheal tubes left in for 4 to 6 days also had no increased incidence of stridor over uncuffed endotracheal tubes (3). The data clearly show that, used appropriately, a cuffed endotracheal tube is safe for the pediatric population and will solve the problem of operating room contamination. It is long overdue that we all abandon the outdated practice of uncuffed endotracheal tubes.
References
Associate Professor, Harvard Medical School, Brigham & Women’s Hospital, and Children’s Hospital, Boston, MA Assistant Professor of Anesthesia, Duke University Medical Center, Durham, NC
In Response:
We would like to thank Dr. Dunn for his comments and truly appreciate his interest in reducing pollution of the operating room environment. We do feel however, that he missed the focus of our study and our shared concern. Though it may be preferable to employ a cuffed endotracheal tube in most clinical circumstances where an uncuffed tube is used, many clinicians persist in using the uncuffed variety. For those clinicians and clinical circumstances where an uncuffed endotracheal tube is used, the Anesthetic Scavenging Hood will effectively scavenge the waste anesthetic gas before it pollutes the operating room. Dr. Dunn’s rebuke of this device may be considered analogous to the thought of not placing catalytic convertors on gasoline powered vehicles, because we should really all be driving electric vehicles. Until that shift occurs, should we not employ a safe and effective means to make today’s air quality better?
We certainly share Dr. Dunn’s concern for immediate access to the patient. The Anesthetic Scavenging Hood was engineered so that above all, it does no harm. The design is such that the device can only fit loosely around the patient as the securement flaps are purposely not long enough to be tied. Should access to the patient be required, the clear, thin, inert hood, can be displaced for immediate patient access.
In addition, the Anesthetic Scavenging Hood can be employed for scavenging of waste anesthetic gas due to leakage from around the cuff of the laryngeal mask airway (1–2).
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
