|LETTER TO EDITOR
|Year : 2013 | Volume
| Issue : 3 | Page : 405-406
Anesthetic management of T tube: A simple approach
Aparna A Nerurkar, Vandana V Laheri, Smita S Lele, Manish Kotwani, Bharati A Tendolkar
Department of Anesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
|Date of Web Publication||27-Aug-2013|
Aparna A Nerurkar
D-104, Presidential Towers, L.B.S. Marg, Ghatkopar (West), Mumbai - 400 086
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nerurkar AA, Laheri VV, Lele SS, Kotwani M, Tendolkar BA. Anesthetic management of T tube: A simple approach. J Anaesthesiol Clin Pharmacol 2013;29:405-6
|How to cite this URL:|
Nerurkar AA, Laheri VV, Lele SS, Kotwani M, Tendolkar BA. Anesthetic management of T tube: A simple approach. J Anaesthesiol Clin Pharmacol [serial online] 2013 [cited 2020 Apr 1];29:405-6. Available from: http://www.joacp.org/text.asp?2013/29/3/405/117057
We read with great interest the case report "Anesthetic management of a patient with Montgomery t-tube in situ for direct laryngoscopy."
The authors were able to achieve an induction with 3-4% sevoflurane in 100% oxygen.  This appears to be technically difficult in view of considerable loss of gases through the open laryngeal end of the intraluminal limb. An appropriate sized red rubber suction catheter inserted trans-laryngeally into the open intraluminal limb could have hastened the process of induction. However this could prove to be technically difficult.
Alternate maneuvers which could have been used include keeping the oral cavity closed tightly with slight jaw retraction and pinching of nostrils to prevent escape of gases.
Inability to ventilate due to the proximal air-leak with ventilation via the extraluminal limb using standard endotracheal tube connector, as well as failure of bag-valve-mask ventilation while occluding the extraluminal limb with a stopper has been described recently.  The emergency case required removal of the T-tube and insertion of orotracheal tube.
Another method we have successfully used is the insertion of a small appropriate sized endotracheal tube, either 4 or 4.5 mm ID, through the extraluminal limb into the tracheal end of the intraluminal limb [Figure 1] and [Figure 2]. This obviates the laryngeal leak sufficiently. The use of Fogarty's catheter, which can introduce technical difficulties as rightly pointed out by the authors, is thus avoided. The resistance offered by the length that requires to be inserted is slightly higher as compared to use of number four universal connector used by the authors but acceptable.
Similar technique has been successfully used for mechanical ventilation in ventilator dependent patient as reported by Wu et al. 
Considering the increasing use of T-tubes and as yet relative unfamiliarity of this device, we feel that the above simple techniques would prove useful in managing patients with T-tube in situ coming for anesthesia.
| References|| |
|1.||Kerai S, Gupta R, Wadhawan S, Bhadoria P. Anesthetic management of a patient with Montgomery t-tube in-situ for direct laryngoscopy. J Anaesthesiol Clin Pharmacol 2013;29:105-7. |
|2.||Touma O, Venugopal N, Allen G, Hinds J. Emergency airway management in a patient with a Montgomery T-tube in situ. Br J Anaesth 2011; 107 (1):107-108. |
|3.||Wu C-Y, Liu Y-H, Hsieh M-J, Ko P-J. Use of the Montgomery T-tube in ventilator-dependent patients. Eur J Cardiothorac Surg 2006;29:122-4. |
[Figure 1], [Figure 2]