Perforation of oesophagus by tracheal tube during resuscitation

Eldor, Joseph; Ofek, Boaz; Abramowitz, Harry B.

doi:10.1111/j.1365-2044.1990.tb14539.x

Cited by 12 publications

(6 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, serious complications, such as dental damage, vocal cord paralysis or oesophageal perforation, are extremely unlikely. In fact, use of the Combitube during the high‐risk period of blind emergency airway management of critically ill emergency patients has resulted in only a 0.7% incidence of major complications [17]; similar complications have also been described for conventional tracheal intubation [18].…”

Section: Discussionmentioning

confidence: 99%

The oesophageal–tracheal Combitube Small Adult™An alternative airway for ventilatory support during gynaecological laparoscopy

et al. 2000

View full text Add to dashboard Cite

SummaryAirway management during gynaecological laparoscopy is complicated by intraperitoneal carbon dioxide inflation, Trendelenburg tilt, increasing airway pressures and pulmonary aspiration risk. We investigated whether the oesophageal±tracheal Combitube 37 Fr SAe is a suitable airway during laparoscopy. One hundred patients were randomly allocated to receive either the Combitube SAe (n 49) or tracheal intubation (n 51). Oesophageal placement of the Combitube was successful at the first attempt [16 (3) s]. Peak airway pressures were 25 (5) cmH 2 O. An airtight seal was obtained using air volumes of 55 (13) ml (oropharyngeal balloon) and 10 (1) ml (oesophageal cuff). Significant correlations were observed between patient's height and weight and the balloon volumes necessary to produce a seal. Similar findings were recorded for the control group, with tracheal intubation being difficult in three patients. The Combitube SAe provided a patent airway during laparoscopy. Non-traumatic insertion was possible and an airtight seal was provided at airway pressures of up to 30 cmH 2 O. Laparoscopic procedures require increased abdominal pressure and the steep Trendelenburg position in order to visualise the pelvic structures. Consequently, tracheal intubation has been the standard airway for these procedures. However, tracheal intubation has inherent risks and limitations. Although the laryngeal mask airway (LMA) has been used successfully in a large number of these procedures [1,2], there are still considerable theoretical concerns about the use of the LMA for laporoscopy. These concerns include the fact that in 4± 33% of LMA placements, more than one insertion attempt is required [3,4]; the LMA does not provide an airtight seal around the larynx (the usual leak pressures being 15±20 cmH 2 O) [5,6], and finally, in 10±15% of patients the oesophagus is included within the rim of the LMA, directly exposing the oesophagus to positive airway pressures [7,8].

show abstract

Section: Discussionmentioning

confidence: 99%

The oesophageal–tracheal Combitube Small Adult™An alternative airway for ventilatory support during gynaecological laparoscopy

et al. 2000

View full text Add to dashboard Cite

show abstract

“…Oesophageal perforation during conventional tracheal intubation in emergency situations has also been reported. 2 Barotrauma and subcutaneous emphysema are recognized complications of mechanical chest compression and positive pressure ventilation. 3 Furthermore, none of the ETCs employed in these four patients was used according to the manufacturer's recommendations.…”

Section: Complications With the Combitubementioning

confidence: 99%

“…(23% incidence): fluid leak into the protective sheath (2); catheter clotting (2); coiling in the ventricle (1); arrhythmia (2); and inability to obtain a pulmonary artery occlusion waveform (PAOP) (24). There were no pneumothoraces or deaths.…”

mentioning

confidence: 99%

Complications with the Combitube

Krafft¹,

Frass²,

Reed

1998

Can J Anaesth

View full text Add to dashboard Cite

CORRESPONDENCE 823(23% incidence): fluid leak into the protective sheath (2); catheter clotting (2); coiling in the ventricle (1); arrhythmia (2); and inability to obtain a pulmonary artery occlusion waveform (PAOP) (24). There were no pneumothoraces or deaths. The inability to obtain a PAOP waveform is disconcerting since an inability to measure or interpret a PAOP trace might lead to errors in patient management. In the experience of the senior author, inability to obtain a PAOP trace is rare and the high rate we detected suggests a lack of experience or ignorance in the interpretation of haemodynamic data by physicians at all levels and nursing personnel, s In tertiary care teaching intensive care units, the PAC is usually inserted by the ICU resident under supervision. If inaccurate data are utilized in decision making, the results may lead to inaccurate, inadequate, or erroneous therapy with potentially disastrous consequences. 1 We wish to make you aware of these results since we suspect our experience is not unique and suggest that other practitioners may wish to examine their own experience. "The Charlottetown LMA Twist"To the Editor:We have never been satisfied with the classical insertion technique for the LMA. We have developed an easier, faster and less traumatic approach. Since the LMA represents the ultimate oral airway, it might be inserted in the same way. Using our technique the LMA is held so that the long axis is perpendicular to the posterior pharyngeal wall of a supine patient with the breathing grille opening caudally. The body of the LMA now has a slight cephalad curve. The LMA is now rotated 180 ~ so that the grille opens in a cephalad direction. With the patient anaesthetized and the LMA lubricated and minimally inflated, the head is extended backward with the left hand on the forehead to open the mouth.Holding the stem with the right hand, the LMA is introduced into the mouth and pushed into the hypopharynx. This is easy as the natural deflection is now caudal and the inflated cuff makes a softer, blunter and easier presentation to the airway. The LMA is felt as it enters the hypopharynx. Whilst firmly pushing firmly on the stem of the LMA, it is rotated 180 ~ twisting the breathing grille toward the glottis. A distinct pop is felt by the introducing hand. The rotation is initiated as soon as the distal part oft.he LMA is seen or felt to be engaged in the hypopharyrLx and while there is still a forward motion of the LMA.We present this as the "Charlottetown Twist" technique of LMA insertion. Liquid crystal temperature indicatorsa potentially serious problem in paediatric anaesthesiaTo the Editor: Liquid crystal temperature indicators (LTCI) placed on the forehead of children are often used to measure the child's temperature during induction of anaesthesia. We have observed that if a heating lamp is placed over the child's head, even at the prescribed distance of 28 inches (71 cm), the temperature values on the LTCI can increase quickly and alarmingly. The first time we observed this d...

show abstract

“…While only few major complications are described in the literature, Vezina et al found that utilisation of the ETC during blind insertion into the airway of critically ill emergency patients resulted in a 4.3% incidence rate of major complications (emphysema, tracheal injury, oesophageal perforation and upper airway bleeding) (21). Similar complication rates are also found after conventional ETI (22). However, several confounding factors have to be considered when assessing the ETC in an emergency setting.…”

Section: Introductionmentioning

confidence: 99%

Ventilation with the esophageal-tracheal Combitube during general anaesthesia: assessing complications in 540 patients

Harrison

Pajenda

Szarpak

et al. 2023

ujms

View full text Add to dashboard Cite

Background: The esophageal-tracheal Combitube (ETC) was developed for the management of difficult airways but can also be used for general anaesthesia. Methods: This clinical study collected data from patients undergoing anaesthesia with the ETC in order to assess the rate of complications. Results: Five hundred forty patients were ventilated with the ETC. In 94.8% (512/540), insertion was performed for the first time by the respective physician. The following minor complications were observed: 38.7% sore throat, 30.9% blood on tube as sign of mucosal lesions and 17.0% cyanotic tongue. Experience decreased the risk of mucosal lesions (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.5–3.5). A higher than recommended volume of the oropharyngeal cuff was associated with blood on the ETC (OR: 1.5, 95% CI: 1.0–2.3) and tongue cyanosis (OR: 2.3, 95% CI: 1.4–3.7). Ventilation for more than 2 h was associated with tongue cyanosis (OR: 2.2, 95% CI: 1.6–3.1) and tongue protrusion (OR: 1.4, 95% CI: 1.1–1.9). Conclusion: We conclude that the Combitube may be used for short procedures requiring general anaesthesia, but the high rate of minor complications limits its value when other alternatives such as a laryngeal mask airway are available. The tested method appears safe regarding major complications, but minor complications are common. Adherence to recommended cuff volumes, experience with the ETC and limiting its use to surgeries lasting less than 2 h might reduce the rate of complications.

show abstract

Perforation of oesophagus by tracheal tube during resuscitation

Cited by 12 publications

References 5 publications

The oesophageal–tracheal Combitube Small Adult™An alternative airway for ventilatory support during gynaecological laparoscopy

The oesophageal–tracheal Combitube Small Adult™An alternative airway for ventilatory support during gynaecological laparoscopy

Complications with the Combitube

Ventilation with the esophageal-tracheal Combitube during general anaesthesia: assessing complications in 540 patients

Contact Info

Product

Resources

About