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Table of Contents
LETTERS TO EDITOR
Year : 2019  |  Volume : 35  |  Issue : 3  |  Page : 407-408

Foley catheter-based inexpensive, indigenous airway device


Department of Anesthesia and Critical Care, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, India

Date of Web Publication3-Sep-2019

Correspondence Address:
Dr. G P Deepak
Department of Anesthesia and Critical Care, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_162_18

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How to cite this article:
Deepak G P, Sarma R, Kumar R, Kumar S. Foley catheter-based inexpensive, indigenous airway device. J Anaesthesiol Clin Pharmacol 2019;35:407-8

How to cite this URL:
Deepak G P, Sarma R, Kumar R, Kumar S. Foley catheter-based inexpensive, indigenous airway device. J Anaesthesiol Clin Pharmacol [serial online] 2019 [cited 2019 Sep 21];35:407-8. Available from: http://www.joacp.org/text.asp?2019/35/3/407/265901



Madam,

We report an indigenously prepared airway topicalization device using the principle of atomization made from the material available in the operation room (OR) with limited resources.

Airway preparation for awake nasal endoscope-guided intubation, in addition to the use of antisialagogue and nasal vasoconstrictor, is achieved by airway topicalization. These include using lignocaine-soaked nasal pledgets (4%), lignocaine viscous gargling (2%), 10 and 15% lignocaine spray, 4% lignocaine nebulization, atomization of local anesthetic drug, nerve blocks, and transtracheal local anesthetic injection (lignocaine 1%–2%).[1] Lignocaine spray needs oral access hence cannot be used when patient is not able to open the mouth. In addition, spray as you go (SAYGO) or drop as you go can be added to any of these combinations.[2] Out of these, atomization may be the most effective single method of complete supraglottic topicalization.[1] Keeping this in mind, we made our atomization-cum-oxygenation device for airway topicalization.

This requires a Foley catheter, a 3-way connector, a lignocaine-filled syringe, and an oxygen source. The Foley catheter is cut obliquely from its patient end so that a length measuring from the tip of the nose to the tragus of the patient + 2 cm is available beyond the Y (where the cuff inflating and drainage tubes meet) [Picture 1]. Once the catheter is cut, its inflating port is connected to a 3-way connector. The Foley catheter is lubricated and is gently slid along the floor of the patient's nose. One end of the 3-way connector (kept in ON position) is now connected to oxygen tubing and oxygen flow is started at 3–6 L/min. A 5 ml lignocaine (1 or 2%) filled syringe is attached to the other port (kept in OFF position). With the thumb of the hand holding the syringe applying gentle pressure on the plunger, the 3-way knob is turned such that both its ports (one connected to O2 and the other to the syringe) are open. As the drug is now injected with continuous flow through the smaller lumen, oxygen atomizes it into fine mist that appears at the cut end [Picture 2]. As the atomization begins, the process is continued at a steady pace while the catheter is pulled out gently with rotatory motion, thereby topicalizing the whole passage. Repeating the procedure in other nasal cavity completes topicalization of nasal route. The device can be tested ex vivo, before using it in the patient, to quantify the appropriate O2 flow rate and injection speed needed to get the desired atomization.



Commercially available lignocaine spray (10 or 15%) delivers 10–15 mg lignocaine per puff and one bottle can be used for many patients. However, their nozzle gets unsterile after each use. Commercial atomization devices produce fine atomized spray (30–100 microns) and can effectively topicalize most of upper airway quickly and have proven efficacy.[1] Our device offers (i) the speed of action of atomization without being as costly, (ii) sterile interface of desired thickness and length for each patient, (iii) softer and longer tubing than the nozzles of commercial sprays, and (iv) option to be used for oral topicalization as well by inserting a stylet inside the bigger lumen and then molding the catheter to the desired shape.

Although our device has the limitation that the size of particles created is not defined and pushing plunger of the syringe too fast or slow may not create mist, the same is true about the commercial atomization devices as well.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

No financial support was taken from institution or hospital.

Conflicts of interest

There are no conf licts of interest.



 
  References Top

1.
Pani N, Kumar Rath S. Regional & topical anaesthesia of upper airways. Indian J Anaesth 2009;53:641-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Williams KA, Barker GL, Harwood RJ, Woodal NM. Combined nebulization and spray-as-you-go topical local anaesthesia of the airway. Br J Anaesth 2005;95:549-53.  Back to cited text no. 2
    




 

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