Airway management with the Combitube during anaesthesia and in an emergency

The oesophageal-tracheal Combitube (Kendall-Sheridan Catheter Corp., Argyle , NY) is a device designed for difficult airways and emergency intubation. The manufacturer recommends that the Combitube size 37F SA be used in patie nts with a height of between 122 and 152 cm. The aim of this study was to e valuate whether ventilation is effective and reliable in anaesthetized pati ents taller than 152 cm using the size 37F SA in the oesophageal position. We also evaluated whether airway protection is adequate and whether direct intubation of the trachea with the Combitube inserted in the oesophagus is possible. We studied 15 adult patients undergoing routine general anaesthes ia and 20 patients who required emergency intubation following trauma. They were between 150 and 180 cm in height. Under direct vision, a size 37F SA Combitube was inserted into the oesophagus of all the patients undergoing r outine general anaesthesia (control group). Blind insertion was performed i n the emergency patients (emergency group). The pharyngeal balloon was infl ated with a volume titrated to air leak and cuff pressures were measured. D uring surgery, a laryngoscope was inserted into the pharynx with the pharyn geal balloon deflated and the laryngoscopic view was evaluated using the Co rmack-Lehane scale. Ventilation was effective and reliable in all 35 patien ts who were between 150 and 180 cm in height. In addition, a direct relatio nship between the pharyngeal balloon volume and patient height was establis hed (P < 0.05), using linear regression models. The laryngoseopic view of t he glottis was adequate to allow direct tracheal intubation in patients in the control group, so that the Combitube size 37F SA may be used in patient s from 122 to 185 cm in height. The trachea could be directly intubated wit h the Combitube in the oesophageal position in patients with normal airways and in patients involved in trauma. In all patients in the emergency group , blind insertion of the Combitube resulted in the device being placed in t he oesophagus. The airway protection appears to be adequate. (C) 2001 Elsev ier Science Ireland Ltd. All rights reserved.