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Table of Contents
LETTER TO EDITOR
Year : 2012  |  Volume : 28  |  Issue : 4  |  Page : 528

Location of the upper Murphy's eye in the uncuffed Ring, Adair, and Elwyn tube


Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India

Date of Web Publication4-Oct-2012

Correspondence Address:
Sandeep K Mishra
Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.101949

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How to cite this article:
Mishra SK, Ashraf NC, Balchander H, Badhe AS. Location of the upper Murphy's eye in the uncuffed Ring, Adair, and Elwyn tube. J Anaesthesiol Clin Pharmacol 2012;28:528

How to cite this URL:
Mishra SK, Ashraf NC, Balchander H, Badhe AS. Location of the upper Murphy's eye in the uncuffed Ring, Adair, and Elwyn tube. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2019 Jul 21];28:528. Available from: http://www.joacp.org/text.asp?2012/28/4/528/101949

Sir,

In 1975, Ring, Adair, and Elwyn (RAE) described a new design for endotracheal tubes, for use in surgeries of the head and neck, particularly in the pediatric age group. The RAE tube has a preformed bend that fit into the contour of the face and helps position the circuit away from the surgical field. One of the reported disadvantages of the RAE tube is the increased chances of an endobronchial intubation, [1] since the length of the tube distal to the bend is fixed and does not allow for inter-patient morphologic variations. The tubes are available in both cuffed and uncuffed variants. The Murphy's eye was designed to allow gas to pass , should the bevel of the tube be occluded by the wall of the trachea or by any other obstruction. The uncuffed RAE tubes {Sheridan,Hudson Respiratory Inc. "Hudson RCI", Teleflex Medical, USA and Mallinckrodt (Athlone, Ireland)} are provided with two Murphy's eyes for enhanced patient safety and ostensibly to ventilate the left lung in the event of an endobronchial intubation. However, as shown in [Figure 1] the eyes are too close to serve the purpose. We had two cases of inadvertent endobronchial intubation with RAE tube and fiberoptic bronchoscopy revealed both the Murphy's eyes to be in the left main stem bronchus. Weiss et al., [2] described the need for improvement in cuffed preformed pediatric tracheal tubes and also elaborated that uncuffed preformed tracheal tubes were more at risk of inadvertent endobronchial intubation than cuffed preformed tracheal tubes. We propose a change in the design of the uncuffed RAE tube, i.e. sitting the upper (proximal) eye a little higher to serve the aforementioned purpose.
Figure 1: Proposed change in the location of the upper Murphy's eye in the uncuffed RAE tube

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  References Top

1.Black AE, Mackersie AM. Accidental bronchial intubation with RAE tubes. Anaesthesia1991;46:42-3.  Back to cited text no. 1
[PUBMED]    
2.Weiss M, Bernet V, Stutz K, Dullenkopf A, Maino P. Comparison of cuffed and uncuffed preformed oral pediatric tracheal tubes. Paediatr Anaesth 2006;16:734-42.  Back to cited text no. 2
[PUBMED]    


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