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LETTER TO EDITOR
Year : 2011  |  Volume : 55  |  Issue : 1  |  Page : 80-81  

Introduction of flexometallic cuffed endotracheal tube through COBRA perilaryngeal airway


Department of Anaesthesiology, Superspeciality and Government Medical College and Hospital, Nagpur, Maharashtra, India

Date of Web Publication9-Feb-2011

Correspondence Address:
Lulu Fatema Vali
Villa Ruqaiyah, 272, Nelson Square, Near Marina Residency, Chaoni, Nagpur - 440013
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.76585

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How to cite this article:
Vali LF, Khobragade S. Introduction of flexometallic cuffed endotracheal tube through COBRA perilaryngeal airway. Indian J Anaesth 2011;55:80-1

How to cite this URL:
Vali LF, Khobragade S. Introduction of flexometallic cuffed endotracheal tube through COBRA perilaryngeal airway. Indian J Anaesth [serial online] 2011 [cited 2020 Jun 5];55:80-1. Available from: http://www.ijaweb.org/text.asp?2011/55/1/80/76585

Sir,

A 45-year-old male patient weighing 84 kg with diagnosis of pituitary macroadenoma posted for sublabial rhinoseptal trans-sphenoidal pituitary macroadenoma excision. Patient was having features of acromegaly with heavy jaw and large tongue. Airway assessment revealed adequate mouth opening with mallampatti scale class III. Patient was pre-oxygenated for 5 minutes. He was premedicated with intravenous (IV) pantoprazole 40 mg, IV glycopyrrolate 0.2 mg, IV dexamethasone 8 mg, IV midazolam 1 mg and IV fentanyl 50 mcg. The patient was induced with IV propofol 2 mg/kg and IV rocuronium bromide 0.6 mg/kg. Laryngoscopy was performed but we could not intubate the patient as it was Cormark-Lehane grade IV on direct laryngoscopy. We inserted the COBRA perilaryngeal airway (PLA) no. 4 with which patient was successfully ventilated and it was confirmed on auscultation. We were not successful in passing flexometallic tube through COBRA PLA. Hence, we passed a lubricated bougie through COBRA PLA into trachea. After removing COBRA PLA, we did larygoscopy and threaded the cuffed flexometallic tube no. 8.0 over bougie. Bougie was removed and flexometallic endotracheal tube position was confirmed with auscultation and capnography.

In a study conducted by Lee and others, [1] after inserting COBRA PLA, fibre-optic bronchoscope was passed through it and then blind as well as fibre-optic guided intubation was done; but passing a bougie through COBRA PLA [Figure 1] and threading a flexometallic tube over bougie with resultant successful intubation in difficult airway management was a unique experience to be shared.
Figure 1: COBRA PLA with bougie

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   References Top

1.Lee JJ, Kim JA, Gwak MH. Evaluation of COBRA PLA as an airway conduit. Eur J Anaesthesiol 2007;24:852-5.  Back to cited text no. 1
    


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