Canadian Journal of Anesthesia, Vol 32, 639-641, Copyright © 1985 by Canadian Anesthesiologists' Society

Clinical Reports: Intraoperative Aspiration in a Paediatric Patient

¹ Department of Anaesthesia, University of Toronto

Address correspondence to: Department of Anaesthesia, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8.

Aspiration around uncuffed endotracheal tubes in paediatric patients is an uncommon event. Uncuffed endotracheal tubes are commonly used in paediatrics even when the risk of gastric aspiration is significant. A case history is presented of an 8-year-old who aspirated during a laparotomy for bowel obstruction. The patient was intubated with an uncuffed #6.0 Portex endotracheal tube. A small leak was noted during positive pressure ventilation. The aspiration was significant such that the patient required 24 hours of positive end-expiratory pressure (PEEP) in an intensive care unit.

Uncuffed endotracheal tubes are used because postintubation stridor is minimized, the lungs are compliant and the funnel-shaped trachea is more likely to secure the airway from aspiration. An uncuffed tube however, does not completely seal the airway, particularly in the presence of an audible "leak." As a result of this case, we now consider the use of a cuffed endotracheal tube in children whenever a 5.5 internal diameter or larger is required. When the risk of pulmonary aspiration is present, the cuff is inflated to reduce the likelihood of contaminaton of the airway.

Key Words: COMPLICATIONS: aspiration • ANAESTHESIA: paediatric