BRONCHOSCOPY VIA A REDESIGNED COMBITUBE(TM) IN THE ESOPHAGEAL POSITION - A CLINICAL-EVALUATION

Background: The esophageal-tracheal Combitube (Kendall-Sheridan Cathet er Corp., Argyle, NY) is an effective device for providing adequate ga s exchange. However, tracheal suctioning is impossible with the Combit ube placed in the esophageal position. To eliminate this disadvantage, the Combitube was redesigned by creating an enlarged hole in the phar yngeal lumen that allows fiberoptic access, tracheal suctioning, and t ube exchange over a guide wire. Methods: The two anterior, proximal pe rforations of regular Combitubes were replaced by a larger, ellipsoid- shaped hole. After the study was approved by the institutional review board, 20 patients with normal airways (Mallampati I or II) were studi ed. During general anesthesia, patients mere esophageally intubated wi th the Combitube. A flexible bronchoscope was inserted and guided via the modified hole and glottic opening down the trachea. For the replac ement procedure, a J tip guide wire was introduced through the broncho scope. The bronchoscope and the Combitube mere removed and a standard endotracheal tube was advanced over a guide catheter. Results: Broncho scopic evaluation of the trachea and guided replacement of the Combitu be by an endotracheal tube was successful in all 20 study patients. Th e average time needed to perform airway exchange was 90 +/- 20 s (mean +/- SD). Arterial oxygen saturation and end-tidal carbon dioxide leve ls remained normal in all patients. No case of laryngeal trauma was ob served during intubation or the airway exchange procedure. Conclusions : The redesigned Combitube enables fiberoptic bronchoscopy, fine-tunin g of its position in the esophagus, and guided airway exchange in pati ents with normal airways. Further studies are warranted to demonstrate its value in patients with abnormal airways.