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Canadian Journal of Anesthesia 51:96 (2004)
© Canadian Anesthesiologists' Society, 2004

Correspondence

Warming the tracheal tube and kinking

Anil Agarwal, MD

Lucknow, India

To the Editor:

We read with interest the letter on intratracheal kinking of an endotracheal tube by Lee et al.1 The authors highlighted that, in addition to various known causes of obstruction of the endotracheal tube, intratracheal kinking at the site where the inflating lumen opens into the cuff can also cause its obstruction. Their observation is similar to that of Singh et al.2 where the authors could barely pass the endotracheal tube through the nasal cavity following soaking it in warm water. It is well known that thermal softening of the polyvinyl chloride tracheal tube can lead to its distortion and obstruction.3 In the case reported by Lee et al., we postulate that warming the tube to soften it contributed to kinking at the tube’s weakest point, i.e., the site where the inflating lumen opens into the cuff.

We feel that the practice of softening the endotracheal tube should be avoided. If one is unable to intubate with a particular size tube it is better to use a smaller size that can be inserted without causing trauma.

References

1 Lee YW, Lee TS, Chan KC, Sun WZ, Lu CW. Intratracheal kinking of endotracheal tube. Can J Anesth 2003; 50: 311–2.[Free Full Text]

2 Singh B, Gombar KK, Chhabra B. Tracheal tube kinking (Letter). Can J Anaesth 1993; 40: 682.[Medline]

3 Alaya JL, Coe A. Thermal softening of tracheal tubes: an unprecedented hazard of the Bair Hugger active patient warming system. Br J Anesth 1997; 79: 543–5.[Abstract/Free Full Text]





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