title: Poor performance of the pediatric airway exchange catheter in adults with cervical spine immobilization.
abstract: OBJECTIVE
  Use of a pediatric airway exchange catheter (PAEC) has been advocated as a potentially useful adjunct for difficult extubations. We evaluated the laryngeal passing ability of a tracheal tube over a PAEC and compared its success rate between adult patients in the sniffing position and adult patients with simulated cervical spine immobilization created using a manual in-line axial stabilization (MIAS) technique.
  
  
  METHODS
  A total of 100 adult patients were randomized into two groups of equal size with respect to position during the simulated reintubation trial: the MIAS position (Group M) and the sniffing position (Group S). After induction of anesthesia, an 11-F PAEC was placed in the trachea under direct laryngoscopic view, and a wire-reinforced tube (with its bevel facing to the left) was gently railroaded over the PAEC and into the trachea. If insertion was impeded, a second attempt was made after rotating the tube 90 degrees counterclockwise. If this also failed, one additional attempt was made using external laryngeal pressure before changing to conventional laryngoscopic intubation.
  
  
  RESULTS
  After the second attempt, the cumulative success rates in Groups M and S were 41.3% and 72.3%, respectively (P = 0.003). After three attempts, the overall success rate was significantly lower in Group M (52.2%) than in Group S (76.6%) (P = 0.018).
  
  
  CONCLUSIONS
  Owing to the high failure rate of PAEC-guided intubation in patients with simulated cervical spine immobilization, use of a PAEC is not recommended for maintaining continuous airway access after extubation in adult patients with cervical immobility or instability.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, 1 Hwayang-Dong, Gwanggin-Gu, Seoul 143-701, South Korea. dikei@kuh.ac.kr
authors.forename: Duk-Kyung
authors.initials: DK
authors.lastname: Kim
authors.forename: Hae-Kyoung
authors.initials: HK
authors.lastname: Kim
authors.forename: Kyoung-Min
authors.initials: KM
authors.lastname: Lee
authors.forename: Hwa-Yong
authors.initials: HY
authors.lastname: Shin
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Ryu
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia; D002404:Catheterization / Q000379:methods*; D002574:Cervical Vertebrae; D002648:Child; D005260:Female; D006801:Humans; D007103:Immobilization; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D007830:Larynx / Q000033:anatomy & histology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013131:Spine; D016896:Treatment Outcome; D055815:Young Adult