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Correspondence |
Rome, Italy
To the Editor:
The Cobra Perilaryngeal Airway (CPLATM; Engineered Medical Systems, Indianapolis, IN, USA) is a new supraglottic device1,2 with an inflatable cuff and a softened and widened distal end (Cobra head). At the distal end of the CPLATM head there are a series of slots (Figure
) which hold the epiglottis out of the way and allow passage, if necessary, of a fibrescope or endotracheal tube (ETT). We report the first case of acute postsurgical stridor successfully diagnosed and treated with the CPLATM.
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After completion of total thyroidectomy the patient was awakened and extubated; dyspnea and inspiratory stridor quickly appeared. The patient was oxygenated with a face mask and SpO2 remained stable. Due to persistent stridor and dyspnea the patient was sedated with iv propofol and a CPLATM size 5 was inserted. Satisfactory ventilation was achieved. A fibrescope was inserted through the CPLATM breathing channel using an adaptor with the patient ventilating spontaneously. The fibrescope, passed through the slotted distal openings, allowed an unobstructed view of the vocal cords that appeared hyperemic, edematous and fixed in midline position. A 7.5-ID, armored ETT was inserted via the CPLATM under direct fibreoptic view.
Morbidity and respiratory complications are frequent after total thyroidectomy, with an incidence of up to 8%.3,4 The clinical presentation is always air hunger, stridor and airway obstruction. Thus, it is necessary to have a technique allowing a rapid and safe diagnosis and treatment.
The use of the CPLATM allows for rapid airway control1,2 and easy passage of the fibrescope to verify vocal cord mobility. One advantage of the CPLATM is that a larger size ETT (8 ID) can be passed as opposed to the Laryngeal Mask Airway (LMA) ClassicTM (The Laryngeal Mask Company Ltd., Maidenhead, Berkshire, UK) and the Laryngeal TubeTM (LT; VBM Medizintechnik, GmbH, Sulz, Germany).5 Further, the relatively short length of the CPLATM (compared to the LMA ClassicTM) allows passage of the ETT cuff completely beyond the vocal cords.
In summary, use of the CPLATM in this patient with stridor after thyroidectomy allowed a rapid diagnosis and appropriate treatment of airway obstruction.
Footnotes
Source and financial support: none
References
1 Agro F, Barzoi G, Carassiti M, Galli B. Getting the tube in the oesophagus and oxygen in the trachea: preliminary results with the new supraglottic device (CobraTM) in 28 anaesthetised patients (Letter). Anaesthesia 2003; 58: 920–1.[Medline]
2 Agro F, Barzoi G, Galli B. The CobraPLATM in 110 anaesthetized and paralysed patients: what size to choose? (Letter). Br J Anaesth 2004 (in press).
3 Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 2002; 128: 389–92.
4 Rosato L, Avenia N, De Palma M, Gulino G, Nasi PG, Pezzullo L. Complications of total thyroidectomy: incidence, prevention and treatment (Italian). Chir Ital 2002; 54: 635–42.[Medline]
5 Agro F, Galli B, Ravussin P. Preliminary results using the laryngeal tube for supraglottic ventilation (Letter). Am J Emerg Med 2002; 20: 57–8.[Medline]
This article has been cited by other articles:
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  F. Agro, M. Carassiti, C. Magnani, and D. Alfery Airway control via the CobraPLATM during percutaneous dilatational tracheotomy in five patients: [Le controle des voies aeriennes par le CobraPLATM pendant la tracheotomie dilatatrice percutanee chez cinq patients] Can J Anesth, April 1, 2005; 52(4): 418 - 420. [Abstract] [Full Text] [PDF]
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