This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Mayhew, J. F. Articles by Muraika, L. A. Search for Related Content PubMed PubMed Citation Articles by Mayhew, J. F. Articles by Muraika, L. A.

---

LETTERS TO THE EDITOR

Continuous Monitoring of the End Tidal CO₂ Ensures that the Endotracheal Tube Remains in Place During the Removal of the LMA

Department of Pediatric Anesthesiology, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AK

To the Editor:

I read with interest the report of Muraika et al. (1) on their technique for intubating the trachea of a child with a difficult airway through a laryngeal mask airway (LMA). I would like to call the writers’ attention to this author’s and others’ (2,3) reports of using an endotracheal tube one-half smaller as an extender for removing the LMA. We have described this technique and the advantage that nothing must be cut or modified, and that continuous monitoring of the end tidal carbon dioxide ensures that the endotracheal tube remains in place during the removal of the LMA.

References

1. Muraika L, Heyman JS, Shevchenko Y. Fiberoptic tracheal intubation through a laryngeal mask airway in a child with Treacher Collins syndrome. Anesth Analg 2003; 97: 1298–9.[Abstract/Free Full Text]
2. Nguyen NH, Morvant EM, Mayhew JF. Anesthetic management for patients with arthrogryposis, multiple congenita, and severe micrognathia: case reports. J Clin Anesth 2000; 12: 227–30.[Web of Science][Medline]
3. Otawa S, Mayhew JF, Woodson L, Manning R, Peterson P. Fiberoptic intubation through a laryngeal mask airway in a child with Pierre-Robin syndrome. J Anesth 1999; 26: 221–2.

Response

St. Christopher’s Hospital for Children, Philadelphia, PA

In Response:

Variations of the technique Dr. Mayhew mentioned for removing an LMA while maintaining endotracheal tube position has been used with success. It seems that most authors either wedged two tubes of the same internal diameter together (1–3) or used the technique you described and inserted an ETT one half to one size smaller into the desired intubating tube (4). As you pointed out in your letter, our technique does involve the additional step of cutting the endotracheal tube connector. However, we feel not only does the use of the cut endotracheal tube connector make our arrangement unique, but it might also prove to be a more secure connection and prevent the endotracheal tube of smaller or similar diameter from slipping out of its mate.

References

1. Reynolds PI, O’Kelly SW. Fiberoptic intubation and the laryngeal mask airway. Anesthesiology 1993; 79: 5.[Web of Science][Medline]
2. Theroux MC, Dettrick RG, Khine HH. Laryngeal mask and fiberoptic endoscopy in an infant with Schwartz-Jampel syndrome. Anesthesiology 1994; 82: 605.
3. Johnson CM, Sims C. Awake fiberoptic intubation via a laryngeal mask in an infant with Goldenhar’s syndrome. Anesth Intensive Care 1994; 22: 194–7.[Web of Science][Medline]
4. Chadd GD, Walford AJ, Crane DL. The 3.5/4.5 modification for fiberscope-guided tracheal intubation using the laryngeal mask airway. Anesth Analg 1992; 75: 307–8.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Mayhew, J. F. Articles by Muraika, L. A. Search for Related Content PubMed PubMed Citation Articles by Mayhew, J. F. Articles by Muraika, L. A.