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The Parker Flex-Tip tube is useful for Airway Scope-assisted intubation
Correspondence [4] Somri M, Tome R, Yanovski B, et al. Combined spinal-epidural anesthesia in major abdominal surgery in high-risk neonates and infants. Paediatr Anaesth 2007;17:1059-65. [5] Williams RK, McBride WJ, Abajian JC. Combined spinal and epidural anaesthesia for major abdominal surgery in infants. Can J Anaesth 1997;44(Pt 1):511-4. [6] Broadman LM. Use of spinal or continuous caudal anesthesia for inguinal hernia repair in premature infants: are there advantages? Reg Anesth 1996;21(6 Suppl):108-13. [7] Seefelder C, Hill DR, Shamberger RC, Holzman RS. Awake caudal anesthesia for inguinal surgery in one conjoined twin. Anesth Analg 2003;96:412-3. [8] Schwartz D, Raghunathan K, Dunn S, Connelly NR. Ultrasonography and pediatric caudals. Anesth Analg 2008; 106:97-9. [9] Chawathe MS, Jones RM, Gildersleve CD, Harrison SK, Morris SJ, Eickmann C. Detection of epidural catheters with ultrasound in children. Paediatr Anaesth 2003;13:681-4. [10] Roberts SA, Galvez I. Ultrasound assessment of caudal catheter position in infants. Paediatr Anaesth 2005;15:429-32. [11] Willschke H, Bosenberg A, Marhofer P, et al. Epidural catheter placement in neonates: sonoanatomy and feasibility of ultrasonographic guidance in term and preterm neonates. Reg Anesth Pain Med 2007;32:34-40.
The Parker Flex-Tip tube is useful for Airway Scope-assisted intubation To the Editor: A new video laryngoscope, the Airway Scope (Hoya, Tokyo, Japan), allows a view of the glottis while providing reliable intubation with an endotracheal tube (ETT) [1]. A standard ETT advances only straight along the Airway Scope tube guidance channel (Intlock blade; GE Plastics, Pittsfield, MA, USA) to the target point; however, a standard ETT, including double-lumen tube (DLT), occasionally hits against the structures around the vocal cord, especially the right arytenoids, preventing intubation [2]. The Parker FlexTip tube (Parker Medical, Englewood, CO, USA), has a soft, flexible, curved, centered distal tip. This beveled tip tends to move easily over the arytenoid so as to prevent trauma to the laryngeal structures [3]. A 48 year-old, 51 kg woman was scheduled for elective lung resection surgery for lung cancer. On arrival at the operating room, she was given intravenous propofol 1.5 mg/ kg, vecuronium 0.1 mg/kg, and fentanyl 50 μg. Mask ventilation was easy, and oxygen saturation was maintained at 100%. The tip of the Airway Scope blade was advanced beneath the epiglottis, allowing easily visualization of the glottic opening. We could not advance the 35-French DLT into the glottic opening because the right arytenoid obstructed the tip of the DLT. Several maneuvers, including re-positioning of the Airway Scope blade and laryngeal shift by an assistant, allowed the DLT to advance into the trachea.
307 At the end of the 4-hour surgery, a change from DLT to an ETT was required. To avoid laryngeal trauma, a Parker FlexTip tube was chosen. Although the Airway Scope view of the glottic opening was similar to the previous view, the Parker Flex-Tip tube was smoothly advanced through the arytenoid cartilage and vocal cords into the trachea, without striking the arytenoids. The combination of the Airway Scope and the Parker Flex-Tip tube facilitates smooth passage of the ETT through the arytenoid. Hirotoshi Kitagawa MD, PhD (Assistant Professor) Yasuhiko Imashuku MD (Assistant Professor) Shiga University of Medical Science Otsu, Shiga, 525-2192, Japan E-mail address: [email protected] Toji Yamazaki MD, PhD (Chief, Department of Anesthesiology) National Hospital Organization Kinki-Chuo Chest Medical Center Osaka, 591-8555, Japan doi:10.1016/j.jclinane.2009.08.002
References [1] Suzuki A, Toyama Y, Katsumi N, et al. The Pentax-AWS® rigid indirect video laryngoscope: clinical assessment of performance in 320 cases. Anaesthesia 2008;63:641-7. [2] Asai T, Liu EH, Matsumoto S, et al. Use of the Pentax-AWS® in 293 patients with difficult airways. Anesthesiology 2009;110:898-904. [3] Kristensen MS. The Parker Flex-Tip tube versus a standard tube for fiberoptic orotracheal intubation: a randomized double-blind study. Anesthesiology 2003;98:354-8.
A case of central cord syndrome following thyroidectomy To the Editor: A 69 year-old, 151 cm, 43.5 kg woman underwent right hemithyroidectomy and lymph node dissection for thyroid cancer. She had slight numbness in her fingers caused by cervical spondylosis myelopathy; these symptoms were not aggravated by neck extension. Anesthesia was induced and maintained with propofol, remifentanil, and fentanyl. The trachea was easily intubated with a Macintosh laryngoscope 7.0 mm tube (CormackLehane classification II). The lungs were ventilated with
The Parker Flex-Tip tube is useful for Airway Scope-assisted intubation To the Editor: A new video laryngoscope, the Airway Scope (Hoya, Tokyo, Japan), allows a view of the glottis while providing reliable intubation with an endotracheal tube (ETT) [1]. A standard ETT advances only straight along the Airway Scope tube guidance channel (Intlock blade; GE Plastics, Pittsfield, MA, USA) to the target point; however, a standard ETT, including double-lumen tube (DLT), occasionally hits against the structures around the vocal cord, especially the right arytenoids, preventing intubation [2]. The Parker FlexTip tube (Parker Medical, Englewood, CO, USA), has a soft, flexible, curved, centered distal tip. This beveled tip tends to move easily over the arytenoid so as to prevent trauma to the laryngeal structures [3]. A 48 year-old, 51 kg woman was scheduled for elective lung resection surgery for lung cancer. On arrival at the operating room, she was given intravenous propofol 1.5 mg/ kg, vecuronium 0.1 mg/kg, and fentanyl 50 μg. Mask ventilation was easy, and oxygen saturation was maintained at 100%. The tip of the Airway Scope blade was advanced beneath the epiglottis, allowing easily visualization of the glottic opening. We could not advance the 35-French DLT into the glottic opening because the right arytenoid obstructed the tip of the DLT. Several maneuvers, including re-positioning of the Airway Scope blade and laryngeal shift by an assistant, allowed the DLT to advance into the trachea.
307 At the end of the 4-hour surgery, a change from DLT to an ETT was required. To avoid laryngeal trauma, a Parker FlexTip tube was chosen. Although the Airway Scope view of the glottic opening was similar to the previous view, the Parker Flex-Tip tube was smoothly advanced through the arytenoid cartilage and vocal cords into the trachea, without striking the arytenoids. The combination of the Airway Scope and the Parker Flex-Tip tube facilitates smooth passage of the ETT through the arytenoid. Hirotoshi Kitagawa MD, PhD (Assistant Professor) Yasuhiko Imashuku MD (Assistant Professor) Shiga University of Medical Science Otsu, Shiga, 525-2192, Japan E-mail address: [email protected] Toji Yamazaki MD, PhD (Chief, Department of Anesthesiology) National Hospital Organization Kinki-Chuo Chest Medical Center Osaka, 591-8555, Japan doi:10.1016/j.jclinane.2009.08.002
References [1] Suzuki A, Toyama Y, Katsumi N, et al. The Pentax-AWS® rigid indirect video laryngoscope: clinical assessment of performance in 320 cases. Anaesthesia 2008;63:641-7. [2] Asai T, Liu EH, Matsumoto S, et al. Use of the Pentax-AWS® in 293 patients with difficult airways. Anesthesiology 2009;110:898-904. [3] Kristensen MS. The Parker Flex-Tip tube versus a standard tube for fiberoptic orotracheal intubation: a randomized double-blind study. Anesthesiology 2003;98:354-8.
A case of central cord syndrome following thyroidectomy To the Editor: A 69 year-old, 151 cm, 43.5 kg woman underwent right hemithyroidectomy and lymph node dissection for thyroid cancer. She had slight numbness in her fingers caused by cervical spondylosis myelopathy; these symptoms were not aggravated by neck extension. Anesthesia was induced and maintained with propofol, remifentanil, and fentanyl. The trachea was easily intubated with a Macintosh laryngoscope 7.0 mm tube (CormackLehane classification II). The lungs were ventilated with