FastrachTM tubes: modifying the design for use with the LMA CTrachTM?
Brisbane, Australia
E-mail: french9a{at}yahoo.co.uk
Editor—I would like to congratulate Liu and colleagues1 2 and Timmermann and colleagues3 on their informative articles critically analysing the LMA CTrachTM. I would like to point out that despite the significant improvements of the CTrachTM over the LMA FastrachTM, especially in the ability to observe the tracheal tube passing through the glottis, the manufacturer seems to have failed to make appropriate changes to the design of the FastrachTM tracheal tubes. In particular, the FastrachTM tube has no markings to assist the operator performing the intubation to correctly position the tracheal tube below the glottis. The majority of tracheal tubes currently available have either one or two black lines as intubating guides approximately 2–3 cm proximal to the tracheal tube cuff. These marks should be placed at the level of the glottis to avoid both endobronchial intubation and the tracheal tube cuff being too close to the glottis where it may cause inadvertent damage or partial extubation. The importance of these intubation guides was reviewed in a recent paper.4
To assess the importance of intubation marks on the insertion of a FastrachTM tracheal tube, I have taken two figures from the LCD viewer of the CTrachTM while intubating a manikin. Figure 1 shows the tracheal tube without a mark passing through the glottis. In comparison, Figure 2 shows the same tube with an intubation guide mark drawn with a permanent marker at 3 cm proximal to the tracheal tube cuff. This mark assists an operator placing the tracheal tube to an appropriate depth within the trachea. I would suggest that the FastrachTM tube should have an intubation mark drawn on the posterior surface of the tube so it may be observed via the CCD camera in the bowl of the LMA by the operator as the tube is being inserted through the glottis.
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When using the LMA FastrachTM, the insertion of the tube is ‘blind’ and therefore such an intubation guide mark is unnecessary. The advent of the LMA CTrachTM, however, requires a more appropriately designed Fastrach tracheal tube with visual triggers that assist tracheal intubation.
References
1 Liu EH, Goy RW, Chen FG. An evaluation of poor LMA CTrach views with a fibreoptic laryngoscope and the effectiveness of corrective measures. Br J Anaesth (2006) 97:878–82.
2 Liu EH, Goy RW, Chen FG. The LMA CTrach, a new laryngeal mask airway for endotracheal intubation under vision: evaluation in 100 patients. Br J Anaesth (2006) 96:396–400.
3 Timmermann A, Russo S, Graf BM. Evaluation of the CTrach—an intubating LMA with integrated fibreoptic system. Br J Anaesth (2006) 96:516–21.
4 Chong DY, Greenland KB, Tan ST, Irwin MG, Hung CT. The clinical implication of the vocal cords-carina distance in anaesthetized Chinese adults during orotracheal intubation. Br J Anaesth (2006) 97:489–95.
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