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Canadian Journal of Anesthesia 51:743-744 (2004)
© Canadian Anesthesiologists' Society, 2004

Correspondence

Internal or external diameter?

Tiberiu Ezri, MD*, Marian Weissenberg, MD*, Ofer Yanai, MD*, Michael Sullam-Muggia, MD*, Zion Houri, MD* and Peter Szmuk, MD{dagger}

* Tel Aviv, Israel
{dagger} Houston, Texas

To the Editor:

We read with interest the report by Dillier et al.1 on a case of laryngeal damage in an infant caused by a too large and inappropriately designed cuffed tracheal tube.

We also found a difference of 2 mm in external diameter between two tracheal tubes (produced by Rush and Mallinkrodt respectively) having the same internal diameter (5 mm; FigureGo).



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  		FIGURE Different external diameters of two tracheal tubes having the same internal diameter (5.0 mm). Top: Rüsch (9.51 mm); Bottom: Mallinckrodt (7.48 mm).

 
Interestingly, the American Society for Testing and Materials standards for tracheal tubes contain certain requirements for tracheal tubes (i.e., internal diameter, cuff, Murphy eye, etc.) but do not include recommendations about external diameter.2

While internal diameter is important for the airway resistance, the magnitude of the external diameter may play a role in the development of postintubation airway edema, postintubation croup and subglottic stenosis in pediatric patients. Therefore, when choosing a certain size of tracheal tube in children, both internal and external diameters should be taken into account.

References

1 Dillier CM, Trachsel D, Baulig W, Gysin C, Gerber AC, Weiss M. Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child. Can J Anesth 2004; 51: 72–5.[Abstract/Free Full Text]

2 American Society for Testing and Materials. Standard Specifications for Cuffed and Uncuffed Tracheal Tubes (ASTM F1242-89). Philadelphia: ASTM; 1989.


Related articles in CJA:

REPLY
Markus Weiss, Claudia M. Dillier, and Andreas C. Gerber
CJA 2004 51: 744. [Full Text]  




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