Appropriate placement of intubation depth marks in a new cuffed paediatric tracheal tube.
BACKGROUND
The aim of this study was to evaluate the appropriateness of intubation depth marks on the new Microcuff paediatric tracheal tube.


METHODS
With local Institutional Ethics Committee approval and informed parental consent, we included patients from birth (weighing > or =3 kg) to 16 yr who were undergoing general anaesthesia requiring orotracheal intubation. Tracheal intubation was performed using direct laryngoscopy, the intubation depth mark was placed between the vocal cords, and the tube was taped to the lateral corner of the mouth. The distance between the tube tip and the tracheal carina was assessed by flexible bronchoscopy with the patients in supine, and their head in neutral positions. Tube sizes were selected according to the formula: internal diameter (ID; mm)=(age/4)+3.5 in children > or =2 yr. In full-term newborns (> or =3 kg) to less than 1 yr ID 3.0 mm tubes were used and in children from 1 to less than 2 yr ID 3.5 mm tubes were used. Endoscopic examination was performed in 50 size ID 3.0 mm tubes, and in 25 tubes of each tube size from ID 3.5 to 7.0 mm. Tracheal length and percentage of the trachea to which the tube tip was advanced were calculated.


RESULTS
250 patients were studied (105 girls, 145 boys). The distance from the tube tip to the carina ranged from 1.4 cm in a 2-month-old infant (ID 3.0 mm) to 7.7 cm in a 14-yr-old boy (ID 7.0 mm). Mean tube insertion into the trachea was 53.2% (6.3) of tracheal length with a minimum of 40% and a maximum of 67.6%.


CONCLUSIONS
The insertion depth marks of the new Microcuff paediatric tracheal tube allow adequate placing of the tracheal tube with a cuff-free subglottic zone and without the risk for endobronchial intubation in children from birth to adolescence.
Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland. markus.weiss@kispi.unizh.ch
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Weiss
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Gerber
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Dullenkopf
D000293:Adolescent; D000375:Aging / Q000473:pathology; D000768:Anesthesia, General; D000886:Anthropometry; D001827:Body Height; D001835:Body Weight; D001980:Bronchi; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005547:Foreign Bodies / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D007828:Laryngoscopy; D008297:Male; D014132:Trachea / Q000033:anatomy & histology / Q000254:growth & development