Poor performance of the pediatric airway exchange catheter in adults with cervical spine immobilization.
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.
Kim
Duk-Kyung
DK
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
Kim
Hae-Kyoung
HK
Lee
Kyoung-Min
KM
Shin
Hwa-Yong
HY
Ryu
Jae-Sung
JS
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