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Letters to the Editor: Letters & Announcements

Unexpected Obstruction of a Parker Flex-Tip™ Tracheal Tube in a Patient with Subglottic Stenosis

Cywinski, Jacek B., MD; Zura, Andrew, MD; Doyle, D John, MD, PhD, FRCPC

Section Editor(s): Saidman, Lawrence

Author Information
doi: 10.1213/ane.0b013e3181711091
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To the Editor:

The Parker Flex-Tip™ Tracheal Tube (Parker Medical, Englewood, CO) has a soft, flexible, curved tip with double Murphy eyes. Designed to reduce airway trauma during tracheal intubation, it flexes and yields as it is advanced past protruding airway structures.1 This feature may reduce injury to glottic structures when the tracheal tube is advanced into the trachea over a flexible fiberoptic bronchoscope or other airway guide.2,3 We report here the case of a patient with known difficult airway and subglottic stenosis where a size 6.5 Parker tube was used for awake fiberoptic intubation. Although the initial position of the tip of the tracheal tube was verified by fiberoptic bronchoscopy to be above the stenosis, later during the case, sudden airway obstruction occurred. Repeat fiberoptic bronchoscopy revealed that the curved tip of the tube had curled against the subglottic stenosis, blocking the tracheal lumen. While repositioning of the tracheal tube corrected the obstruction in this instance, because the surgical procedure (revision cranioplasty) required frequent head manipulations, adjustment of the tube was necessary on several occasions.

Use of the Parker Flex-Tip Tracheal Tube in patients with subglottic stenosis can lead to airway obstruction via bending of the tube tip across the tube lumen should the external diameter of the tube be larger than the diameter of the stenotic lesion.

Jacek B. Cywinski, MD

Andrew Zura, MD

D. John Doyle, MD, PhD, FRCPC

Department of General Anesthesiology

Cleveland Clinic

Cleveland, Ohio

[email protected]


1. Available at:, last accessed January 15, 2008
2. Kristensen MS. The Parker Flex-Tip tube versus a standard tube for fiberoptic orotracheal intubation: a randomized double-blind study. Anesthesiology 2003;98:354–8
3. Suzuki A, Tampo A, Abe N, Otomo S, Minami S, Henderson JJ, Iwasaki H. The Parker Flex-Tip tracheal tube makes endotracheal intubation with the Bullard laryngoscope easier and faster. Eur J Anaesthesiol 2008;25:43–7
© 2008 International Anethesia Research Society