Use of Parker Flex-Tip tracheal tube in a patient with Kniest dysplasia

A 37-year-old man with Kniest dysplasia and thoracic myelopathy was scheduled for T3-12 laminectomy. Kniest dysplasia is a severe chondrodysplasia characterized by short trunk and limbs. Awake fiberoptic intubation was attempted to prevent airway obstruction because we had predicted his difficult airway. During fiberoptic tracheal intubation, we easily succeeded in the insertion of the fiberscope itself into the trachea, but were not able to insert the tip of a reinforced tube into the trachea, because the tip of the reinforced tube impinged on laryngeal structures. We succeeded in placing the Parker Flex-Tip tracheal tube into the trachea. We considered that the Parker Flex-Tip tube, having a tip that reduces the gap between the fiberscope and the inside of the tube, resulted in success of the passage of the tube into the trachea during fiberoptic intubation.     

The Parker Flex-Tip tube versus a standard tube for fiberoptic orotracheal intubation: a randomized double-blind study

BACKGROUND: During fiberoptic tracheal intubation, passage of the fiberscope itself to the trachea is often fairly easy, but passage of the tube into the trachea may be difficult or even impossible. A new type of disposable endotracheal tube, the Parker Flex-Tip tube, has a tip that reduces the gap between the fiberscope and the inside of the tube. Thus, theoretically, a smaller risk of impinging on laryngeal structures during insertion in trachea is expected. METHODS: Eighty patients scheduled for elective anesthesia using orotracheal intubation were randomized to either a Parker Flex-Tip tube or a standard (Portex) 7.5-mm-ID endotracheal tube. Blinding was obtained by having the tube premounted on the fiberscope (Olympus LF-1; diameter of fiberscope = 4 mm) and thereafter covered with a black opaque plastic bag. Difficulty in placing the tube was scored using an objective standardized grading system. RESULTS: Seventy-six patients completed the study. The use of the Parker Flex-Tip tube reduced the incidence of need for repositioning of the tube during insertion into trachea from 89% to 29% (P < 0.0001) when compared to the standard tube. The median time for passage of the tube into the trachea was reduced from 20 s to 7.5 s (P < 0.0001). CONCLUSIONS: During oral fiberoptic intubation, the use of the Parker Flex-Tip tube is associated with greater incidence of initial success of passage of the tube into trachea when compared to a standard endotracheal tube.     

The laryngeal tube

The laryngeal tube (VBM Medizintechnic GmbH, Sulz, Germany) is a supraglottic device designed for airway management in spontaneous or positive-pressure ventilation during anesthesia or in cardiopulmonary resuscitation. Currently, the tube is available in 4 versions: the standard laryngeal tube, the disposable tube (LT-D), the dual-lumen tube (with a tube for suction) (LTS II), and the disposable LTS (LTS-D). The design of the tube has been modified several times. It is easy to insert and the airway seal is more effective than that of the laryngeal mask. The incidence of complications is similar for both devices, though use of the laryngeal tube requires more adjustments. The standard tube is somewhat less effective than the ProSeal laryngeal mask, though the new LTS II has been improved considerably. The laryngeal tube is effective as an aid to management of the difficult airway. We reviewed the literature indexed on MEDLINE through December 2006 using the search terms laryngeal tube, anesthesia, equipment, and airway.     

The laryngeal tube

The laryngeal tube (VBM Medizintechnik, Sulz, Germany) is a relatively new extraglottic airway, designed to secure a patent airway during either spontaneous breathing or controlled ventilation. In this review article, we have assessed the potential role of the laryngeal tube during anaesthesia and during cardiopulmonary resuscitation. There are four variations of the laryngeal tube: standard laryngeal tube, disposable laryngeal tube, laryngeal tube-Suction II and disposable laryngeal tube-Suction II. The design of the device has been revised several times. Insertion of the standard laryngeal tube is as easy as with the laryngeal mask airway classic. The laryngeal tube may provide a better sealing effect than the laryngeal mask. The incidence of complications with the two devices is similar, although the laryngeal tube may require more re-adjustments of its position to obtain a clear airway. Compared with the ProSeal laryngeal mask, the laryngeal tube may be less effective. The efficacy of the standard laryngeal tube is unclear, particularly in patients breathing spontaneously or in children. The efficacy of the laryngeal tube Suction-II and disposable devices is also not clear. From the limited number of studies and reports available, it can be concluded that the laryngeal tube is potentially useful in maintaining a clear airway during anaesthesia and cardiopulmonary resuscitation. In addition, the device may be useful as an aid to tracheal intubation.     

The use of the intubating laryngeal mask endotracheal tube with intubating devices

IMPLICATIONS: Despite adequate visualization of the vocal cords using specialized airway devices, anatomical factors and the physical characteristics of the tube may cause difficulty when performing endotracheal intubation. The endotracheal tube designed for use with the intubating laryngeal mask airway may facilitate intubation in these circumstances.     

Retrieval of large colonic polyps: simple use of proctoscope

Retrieval of polyps during colonoscopic procedures can be technically difficult and time consuming. This is particularly the case when attempting to retrieve large polyps intact through the anal canal of an anxious patient with a hypertonic sphincter. In this paper, we describe a simple technique that permits the complete removal of a large polyp intact by using a readily available theater instrument. The success rate of this procedure can be improved with the aid of simple instrument like a proctoscope.     

The Parker Flex-Tip Tube versus a Standard Tube for Fiberoptic Orotracheal Intubation: A Randomized Double-blind Study

Background: During fiberoptic tracheal intubation, passage of the fiberscope itself to the trachea is often fairly easy, but passage of the tube into the trachea may be difficult or even impossible. A new type of disposable endotracheal tube, the Parker Flex-Tip tube, has a tip that reduces the gap between the fiberscope and the inside of the tube. Thus, theoretically, a smaller risk of impinging on laryngeal structures during insertion in trachea is expected.

Methods: Eighty patients scheduled for elective anesthesia using orotracheal intubation were randomized to either a Parker Flex-Tip tube or a standard (Portex) 7.5-mm-ID endotracheal tube. Blinding was obtained by having the tube premounted on the fiberscope (Olympus LF-1; diameter of fiberscope = 4 mm) and thereafter covered with a black opaque plastic bag. Difficulty in placing the tube was scored using an objective standardized grading system.

Results: Seventy-six patients completed the study. The use of the Parker Flex-Tip tube reduced the incidence of need for repositioning of the tube during insertion into trachea from 89% to 29% (P < 0.0001) when compared to the standard tube. The median time for passage of the tube into the trachea was reduced from 20 s to 7.5 s (P < 0.0001).     

The LTD laryngeal tube: a new single-use airway device

Objectives

Clinical study of a new supraglottic single use airway device, the LTD™ with evaluation of insertion, efficiency during intermittent positive pressure ventilation and side effects.

Study design

Prospective, open clinical study.

Patients and methods

Fifty adult patients [33 years (26–55)] were scheduled for elective surgery (orthopaedic, plastic or maxillo-facial) under general anaesthesia less than two hours in dorsal position. No patient presented clinical sign of difficult airway management or risk of regurgitation. We studied easiness and delay for insertion, oro-pharyngeal leak pressure, peak airway pressure with positive pressure ventilation and side effects during the first 24 hours.

Results

Insertion was successful in 94%. Median insertion time was 38 s (32–45). Difficulties of insertions were found in 25%. Oro-pharyngeal leak pressure, always superior than peak pressure [18 cmH₂O (15–21)] increased from 26 cmH₂O (22–32.5) to 34 cmH₂O (29–40) at the end of the surgery. No case of gastric inflation, regurgitation or SpO₂ < 95% were noticed. Moderate sore throat incidence was 6% in recovery room, 15% at the sixth hour and absent at the 24th hour.

Conclusion

The learning curve was low ≤ 10. Insertion is easy. The quality of airway protection allows secure positive pressure ventilation. Postoperative side effects are minor and transient.