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A583
October 14, 2007
9:00 AM - 11:00 AM
Room Hall D, Area D,
Two Thin Airway Exchange Catheters (AEC) Versus One-AEC for Tracheal Tube Exchange
Kaori Kimura, M.D., Akira Suzuki, M.D., Masahiro Uraoka, M.D., Shigehito Sato, M.D.
Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
Background: A thin airway exchange catheter (AEC) is often used for exchange from a double-lumen tracheal tube (DLT) to a single-lumen tracheal tube (SLT). However, passage of the SLT into the trachea througn a AEC may be difficult or even impossible. Impingement of the tracheal tube on upper airway structures occurs commonly during advancement over a AEC. We hypothesized the use of two AECs is more suitable for exchange from a DLT to a SLT. The purpose of this study was to evaluate the effectiveness of using two AECs for tracheal tube exchange.

Methods: Twenty-eight consenting patients underwent a clinically indicated using DLT intubation for thoracic surgery. They were randomaized to either using one-AEC or two-AECs. After induction of anaesthesia, a DLT was inserted into the trachea using direct laryngoscopy.

One and two AECs were inserted into the DLT at the recovery period of the surgery for tracheal tube exchange in the one-AEC group (n=14) and two-AEC group (n=14), respectively.

After the AEC had been positioned in the trachea, a SLT was advanced over the AEC towards the trachea. If resistance to the advance was encountered,

a three step standardized action was taken.

Step 1, withdraw the tube 5cm and rotate it 90-dgree anticlockwise

Step 2, external laryngeal manipulation

Step 3, direct laryngoscopy

The difficulty of placing the tube was scored using an objective four points grading system.

Grade 1, No difficulty passing the tracheal tube

Grade 2, Relieved by withdrawal and 90-degrees anticlockwise rotation

Grade 3, Necessitating more than one maniputation or external laryngeal maniputation

Grade 4, Direct laryngscopy was required

We also measured the duration for tube exchange.

Results. Twenty-eight patients completed the study. The difficulty of passing the tube into the trachea was shown in Table1. There were significantly more successful tube placements at the first attempt (Grade 1) in two-AEC group (73%) than in one-AEC group (0%). The use of two AECs reduced the incidence of need for repositioning of the tube during insertion into trachea when compared to one AECs.

The duration for tube exchange was similar, 107±28 seconds ( mean ± SD ) in one AEC-group, and 117±14 seconds in two- AECs group(N.S.).

Conclusions. During tracheal tube exchange, the use of two AECs is associated with greater incidence of initial success of passage of the tube into the trachea when compared to the use of one AEC.[table1]

Anesthesiology 2007; 107: A583
Difficulty of passing the tracheal tube into the trahea
Gradeone-AEC group (n=14)two-AECs group (n=14)
1011
2103
300
440
AEC, airway exchange catheter