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

Airway management during gynaecological laparoscopy is complicated by intra peritoneal carbon dioxide inflation, Trendelenburg tilt, increasing airway pressures and pulmonary aspiration risk. We investigated whether the oesoph ageal-tracheal Combitube 37 Fr SA(TM) is a suitable airway during laparosco py. One hundred patients were randomly allocated to receive either the Comb itube SA(TM) (n = 49) or tracheal intubation (n = 51). Oesophageal placemen t of the Combitube was successful at the first attempt [16 (3) s]. Peak air way 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 cu ff). Significant correlations were observed between patient's height and we ight and the balloon volumes necessary to produce a seal. Similar findings were recorded for the control group, with tracheal intubation being difficu lt in three patients. The Combitube SA(TM) 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.