The Montgomery T-tube: anaesthetic problems and solutions

The Montgomery T-tube is a device used as a combined tracheal stent and an airway after laryngotracheal surgery. The device is used mostly in speciali st centres for head and neck surgery, and therefore, many anaesthetists may be unfamiliar with its use. The Montgomery T-tube presents the anaesthetis t with challenges both during its surgical insertion when acute loss of the airway might occur and also during induction of anaesthesia in patients wh o have such a tube in situ. Anaesthetists who are unfamiliar with the tube may have to resort to ingenious ways of coping with the problems of a share d airway with a T-tube, which does not have a suitable adaptor for a standa rd catheter mount, as well as controlling and maintaining ventilation throu gh the device. Safe management of such patients requires careful planning. We describe the anaesthetic management of two cases to illustrate the probl ems associated with Montgomery tubes.