LETTER TO EDITOR
Year : 2013 | Volume
: 29 | Issue : 3 | Page : 406--407
Authors' reply: Anesthetic management of a patient with montgomery t-tube in-situ for direct laryngoscopy
Sukhyanti Kerai, Richa Gupta, Sonia Wadhawan, Poonam Bhadoria
Department of Anesthesia, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
Department of Anesthesia, MAMC and Associated LN Hospital, New Delhi
|How to cite this article:|
Kerai S, Gupta R, Wadhawan S, Bhadoria P. Authors' reply: Anesthetic management of a patient with montgomery t-tube in-situ for direct laryngoscopy.J Anaesthesiol Clin Pharmacol 2013;29:406-407
|How to cite this URL:|
Kerai S, Gupta R, Wadhawan S, Bhadoria P. Authors' reply: Anesthetic management of a patient with montgomery t-tube in-situ for direct laryngoscopy. J Anaesthesiol Clin Pharmacol [serial online] 2013 [cited 2020 Jul 8 ];29:406-407
Available from: http://www.joacp.org/text.asp?2013/29/3/406/117060
We would like to thank you for reading our article with interest.
The role of maneuvers-pinching of nostril and keeping oral cavity tightly closed with slight jaw retraction, in hastening induction is doubtful as these would prevent escape of anaesthetic gases into the atmosphere but not to stomach. The gastric insufflation can cause vomiting with grave consequences in patients' with t-tube in situ as their airway is unprotected.
Similarly, insertion of red rubber suction catheter translayngeally into open intraluminal limb prior to induction in patients who are awake is not possible. However, occlusion of upper open end of intraluminal end with bronchial blocker/red rubber suction catheter/pediatric foley's catheter/fogarty catheter which can be inserted under direct laryngoscopic vision once anesthesia is induced is useful for maintaining intraoperative ventilation through extraluminal end provided that these are acceptable to surgeons. As our case was of short duration, intraoperative ventilation was not much problematic, but this technique is more useful in long duration airway surgeries.
The insertion of smaller sized endotracheal (ET) tube  through the extraluminal limb into the tracheal end of intraluminal limb used by author seems acceptable method for short surgical procedures involving upper intraluminal limb. It is a simple method allowing ventilation through extraluminal limb with minimal laryngeal leak but carries disadvantages of increased resistance as pointed out by author. Another difficulty with this technique is lack of correlation between diameters of t-tube and ET tube of same number. So a range of ET tubes should be available for selecting the ET tube which can fit into t-tube of patient. A smaller sized flexometallic ET tube  compared to polyvinyl chloride (PVC) tube will be more suitable option as it easily passes into tracheal end of intraluminal limb and by inflating cuff upward escape of anesthetic gases can be prevented.
|1||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 Surg2006;29:122-4|
|2||Al-Kaisy AA, Kent AP, Watt JWH. Maintaining ventilation through Montgomery t-tube. Can J Anesth 1997; 44:340|