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BRONCHIAL TUBE AND BLOCKER
225
MANAGEMENT OF DIABETIC PATIENTS
neuritis. They are therefore, more liable than others to develop pressure sores on their heels and are readily burnt by hot water bottles. When there is peripheral vascular PERIPHERAL NEURITIS AND PERIPHERAL disease there is often coronary artery VASCULAR DISEASE disease as well, so the dangers of arterial Patients with diabetes, particularly if anoxia or hypotension during anaesthesia they have had the disease for some years, need always to be borne in mind. are likely to have impaired circulation REFERENCE through their feet and diabetic peripheral Griffiths, J. A. (1953). Quart. J. Med., 22, 405
the only safeguard is a stomach washout with a wide tube before the patient is anaesthetized.
BRONCHIAL TUBE AND BLOCKER
Sirs,—As anaesthetists engaged in anaesthesia for chest surgery we were very interested in the bronchus tube and blocker described by Sir Robert Macintosh and R. A. L. Leatherdale in the British Journal of Anaesthesia (1955, 27, 556). Over the last few years such special methods have very largely fallen into disuse as the indications for them have greatly diminished. We feel, however, that these techniques should still be practised as the indications for them, though fewer, will always continue. For that reason the article of Macintosh and Leatherdale is welcome. We would, however, like to make the following comments. (1) Certain disadvantages attach to blind placement of tubes and blockers. (a) It is essential that accurate placing of such a tube or blocker should be obtained and may not be certain with blind intubation. (b) Blind intubation increases the risk of producing haemorrhage from local disease. (c) Gross distortion of the trachea and main bronchi in disease makes intubation even under direct vision very difficult. (d) Any secretions can be aspirated more effectively. For these reasons we advocate " direct vision " insertion as advocated by Magill as long ago as
1928 and used in various modifications since that time. (2) The blocker described would appear to be fixed to the endotracheal tube and therefore the balloon may be too far in or not far enough, since the bronchial tree varies from patient to patient. (3) The normal practice is to remove the blocker as the bronchus is clamped. What happens to the balloon of the tube described? Is it not likely that the blocker balloon may be " decapitated " when the bronchus is divided? (4) We presume the tube and blocker illustrated in figures 2 and 6 are similar to the Sturtzbecher tube manufactured by Willy Rusch, K.G. (Stuttgart) and seen by one of us at the Munich Surgical Conference 1953. (5) We would commend the incorporation of the small aspiration catheter in the endobronchial tube. R. MACHRAY RUTH E. MANSFIELD B. G. B. LUCAS I. ENGLISH
Brompton Hospital, London, S.W3 REFERENCES
Magill, I. W. (1928). Proc. Roy. Soc. Med., 22, 83. (1935). Proc. Roy. Soc. Med., 4, 335.
Downloaded from http://bja.oxfordjournals.org/ at University of Iowa Libraries/Serials Acquisitions on June 28, 2015
CORRESPONDENCE
MANAGEMENT OF DIABETIC PATIENTS
neuritis. They are therefore, more liable than others to develop pressure sores on their heels and are readily burnt by hot water bottles. When there is peripheral vascular PERIPHERAL NEURITIS AND PERIPHERAL disease there is often coronary artery VASCULAR DISEASE disease as well, so the dangers of arterial Patients with diabetes, particularly if anoxia or hypotension during anaesthesia they have had the disease for some years, need always to be borne in mind. are likely to have impaired circulation REFERENCE through their feet and diabetic peripheral Griffiths, J. A. (1953). Quart. J. Med., 22, 405
the only safeguard is a stomach washout with a wide tube before the patient is anaesthetized.
BRONCHIAL TUBE AND BLOCKER
Sirs,—As anaesthetists engaged in anaesthesia for chest surgery we were very interested in the bronchus tube and blocker described by Sir Robert Macintosh and R. A. L. Leatherdale in the British Journal of Anaesthesia (1955, 27, 556). Over the last few years such special methods have very largely fallen into disuse as the indications for them have greatly diminished. We feel, however, that these techniques should still be practised as the indications for them, though fewer, will always continue. For that reason the article of Macintosh and Leatherdale is welcome. We would, however, like to make the following comments. (1) Certain disadvantages attach to blind placement of tubes and blockers. (a) It is essential that accurate placing of such a tube or blocker should be obtained and may not be certain with blind intubation. (b) Blind intubation increases the risk of producing haemorrhage from local disease. (c) Gross distortion of the trachea and main bronchi in disease makes intubation even under direct vision very difficult. (d) Any secretions can be aspirated more effectively. For these reasons we advocate " direct vision " insertion as advocated by Magill as long ago as
1928 and used in various modifications since that time. (2) The blocker described would appear to be fixed to the endotracheal tube and therefore the balloon may be too far in or not far enough, since the bronchial tree varies from patient to patient. (3) The normal practice is to remove the blocker as the bronchus is clamped. What happens to the balloon of the tube described? Is it not likely that the blocker balloon may be " decapitated " when the bronchus is divided? (4) We presume the tube and blocker illustrated in figures 2 and 6 are similar to the Sturtzbecher tube manufactured by Willy Rusch, K.G. (Stuttgart) and seen by one of us at the Munich Surgical Conference 1953. (5) We would commend the incorporation of the small aspiration catheter in the endobronchial tube. R. MACHRAY RUTH E. MANSFIELD B. G. B. LUCAS I. ENGLISH
Brompton Hospital, London, S.W3 REFERENCES
Magill, I. W. (1928). Proc. Roy. Soc. Med., 22, 83. (1935). Proc. Roy. Soc. Med., 4, 335.
Downloaded from http://bja.oxfordjournals.org/ at University of Iowa Libraries/Serials Acquisitions on June 28, 2015
CORRESPONDENCE