BJA Advance Access originally published online on October 14, 2004
British Journal of Anaesthesia 2005 94(1):80-87; doi:10.1093/bja/aeh294
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Appropriate placement of intubation depth marks in a new cuffed paediatric tracheal tube
Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
* Corresponding author. E-mail: markus.weiss{at}kispi.unizh.ch
Background. The aim of this study was to evaluate the appropriateness of intubation depth marks on the new Microcuff paediatric tracheal tube.
Methods. With local Institutional Ethics Committee approval and informed parental consent, we included patients from birth (weighing 
3 kg) to 16 yr who were undergoing general anaesthesia requiring orotracheal intubation. Tracheal intubation was performed using direct laryngoscopy, the intubation depth mark was placed between the vocal cords, and the tube was taped to the lateral corner of the mouth. The distance between the tube tip and the tracheal carina was assessed by flexible bronchoscopy with the patients in supine, and their head in neutral positions. Tube sizes were selected according to the formula: internal diameter (ID; mm)=(age/4)+3.5 in children 2 yr. In full-term newborns (3 kg) to less than 1 yr ID 3.0 mm tubes were used and in children from 1 to less than 2 yr ID 3.5 mm tubes were used. Endoscopic examination was performed in 50 size ID 3.0 mm tubes, and in 25 tubes of each tube size from ID 3.5 to 7.0 mm. Tracheal length and percentage of the trachea to which the tube tip was advanced were calculated.
Results. 250 patients were studied (105 girls, 145 boys). The distance from the tube tip to the carina ranged from 1.4 cm in a 2-month-old infant (ID 3.0 mm) to 7.7 cm in a 14-yr-old boy (ID 7.0 mm). Mean tube insertion into the trachea was 53.2% (6.3) of tracheal length with a minimum of 40% and a maximum of 67.6%.
Conclusions. The insertion depth marks of the new Microcuff paediatric tracheal tube allow adequate placing of the tracheal tube with a cuff-free subglottic zone and without the risk for endobronchial intubation in children from birth to adolescence.
Declaration of interest. In the authors' institution cuffed tracheal tubes have been routinely used in children from birth to adolescence since 2000. Dr Weiss and Dr Gerber are involved in the design and evaluation of a new cuffed tracheal tube in co-operation with Microcuff GmbH, Weinheim, Germany. No agreements or financial benefits arise from this co-operation. Dr A. Dullenkopf has been supported by a Clinical Research Grant provided from Microcuff GmbH, Weinheim, Germany for this study.
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