LETTERS TO THE EDITOR
To the Editor:
We read the interesting report of Fung et al (1), which describes the removal of a foreign body (FB) by tracheal backflow air. However, this technique does not exclude the possibility of failure of FB expulsion (and subsequent FB aspiration into the right mainstem bronchus) caused by FB impact on the right vocal cord; the FB dimensions were approximately 4 × 8 mm (1), whereas the maximal space between a 7.5 endotracheal tube (ETT) (outer diameter = 10–10.5 mm) and the vocal cords [maximal width of relaxed glottis = 12 mm (2)] is 2 mm. Furthermore, even in the case of successful FB expulsion (1), the FB might traumatize the right vocal cord.
We would therefore recommend an alternative technique (3) of FB removal: 1) after ventilation with 100% O2, simultaneous insertion of a fiberoptic bronchoscope (FOB) and a 7F Fogarty catheter (FC) into the ETT, FC balloon inflation between the carina and the ETT tip under fiberoptic visualization, and simultaneous ETT and FOB removal (Fig. 1A), 2) insertion of a rigid bronchoscope into the trachea (aside the FC) and FB removal (Fig. 1B), and 3) reintubation of the trachea with a 7.5–8.5 ETT, ETT cuff inflation (Fig. 1C), deflation of the FC balloon and FC removal (Fig. 1C), and resumption of patient ventilation.
Maria J. Tzoufi MD
Spyros D. Mentzelopoulos MD
1. Fung ST, Poon YY, Chong ZK, et al. Removal of an aspirated prosthetic tooth by tracheal backflow air. Anesth Analg 2000; 90: 993–4.
2. Stone DJ, Gal TJ. Airway management. In: Miller RD, ed. Anesthesia. 4th ed. New York: Churchill Livingstone, 1994: 1403–37.
3. Mentzelopoulos SD, Romana CN, Hatzimichalis AG, et al. Anesthesia for tracheal resection: a new technique of airway management in a patient with severe stenosis of the midtrachea. Anesth Analg 1999; 89: 1156–60.