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BJA Advance Access published online on February 6, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh087
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted November 12, 2003

Clinical Investigation

Randomized, controlled trial of the double setup tracheal tube during fibreoptic orotracheal intubation under general anaesthesia

A. H. Jackson 1*, P. Wong 2, B. Orr 3

1 Department of Anaesthetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, New South Wales, Australia
2 Guy’s, King’s and St Thomas’ Hospital Trust, St Thomas Street, London SE1 9RT, UK
3 Department of Anaesthetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, New South Wales, Australia.; University of Sydney, New South Wales 2060, Australia

* To whom correspondence should be addressed. E-mail: andrewhjackson{at}hotmail.com.


  Abstract

Background. Impingement of the tracheal tube (ETT) on upper airway structures during railroading over the fibreoptic bronchoscope (FOB) occurs commonly. Potential complications of impingement include prolonged intubation time, leading to arterial desaturation, failed intubation and laryngeal trauma. The objective of this randomized, controlled trial was to assess the effect of the double setup ETT (a paediatric ETT is placed inside an adult ETT) on the incidence of impingement during orotracheal fibreoptic intubation.

Method. Two hundred patients were randomized to have a single ETT or double setup ETT. After induction of anaesthesia, fibreoptic orotracheal intubation was performed. The degree of impingement of the ETT during advancement over the FOB was assessed using a standardized scoring system based on the manoeuvres required to overcome the impingement.

Results. The incidence of impingement was lower using the double setup ETT compared with the single ETT (18 vs 93%, P<0.001). The double setup ETT also reduced the incidence of impingement requiring more than a simple 90° counterclockwise rotation to achieve intubation (3 vs 14%, P=0.01) and reduced the median intubation time (31 vs 35 s, P=0.046).

Conclusions. The double setup ETT is effective in reducing ETT impingement and in reducing intubation time. We did not find an association between ETT impingement and arterial desaturation.

Br J Anaesth 2004

Keywords: Keywords: anaesthesia, general; equipment, fibreoptic bronchoscope; equipment, tracheal tubes; intubation, tracheal


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Home page
 Br J AnaesthHome page
D. Macnair, K. Barker, and A. Jackson
ETT impingement during railroading over the FOB
Br. J. Anaesth., October 1, 2004; 93(4): 597 - 597.
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