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REPLY

Zurich, Switzerland

We would like to thank Ezri et al. for their interesting comments on our case report.¹ Their illustrations confirm that wire-reinforced tubes not only have a larger outer diameter (OD) than conventional pediatric polyvinyl chloride tracheal tubes but also that similarly designed tubes with identical internal diameter (ID) provided by different manufacturers can reveal large differences in OD.²

We agree that anesthesiologists should take into account both the internal as well as the external diameter when selecting tracheal tubes in children, as mentioned in our case report. Whereas the OD is the more reliable measure when selecting an uncuffed pediatric tracheal tube with appropriate fit and seal in the trachea, for the use of cuffed pediatric tracheal tubes, however, the OD is not essential for tracheal sealing and thus the ID-dependent formulas are usually used.^2–5 Furthermore, most anesthesiologists routinely use the internal tube diameter for age-dependent selection of tracheal tubes in children³ and tracheal tubes are categorized and provided by the manufacturers according to their ID.

Since there are no standardized guidelines for OD in pediatric tracheal tubes and not all anesthesiologists use and know OD formulas for tracheal tube size selection in children, manufacturers should provide specific product-related data for pediatric tube size selection on their tube package.²

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 Weiss M, Dullenkopf A, Gysin C, Dillier CM, Gerber AC. Shortcomings of cuffed paediatric tracheal tubes. Br J Anaesth 2004; 92: 78–88.[Abstract/Free Full Text]

3 Motoyama EK. Tracheal intubation. In: Motoyama EK, Davis PJ (Eds). Smith’s Anesthesia for Infants and Children, 5th ed. St. Louis: CV Mosby Co.; 1990: 272–5.

4 Steward DJ, Lerman J. Techniques and procedures of pediatric anesthesia. In: Steward DJ, Lerman J (Eds). Manual of Pediatric Anesthesia, 5th ed. New York: Churchill Livingstone; 2001: 69–127 (82).

5 Khine HH, Corddry DH, Kettrick RG, et al. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology 1997; 86: 627–31.[Medline]

Related articles in CJA:

Internal or external diameter?

Tiberiu Ezri, Marian Weissenberg, Ofer Yanai, Michael Sullam-Muggia, Zion Houri, and Peter Szmuk
CJA 2004 51: 743-744. [Full Text]  

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Related articles in CJA Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Weiss, M. Articles by Gerber, A. C. Search for Related Content PubMed Articles by Weiss, M. Articles by Gerber, A. C.