Ventilation with the esophageal-tracheal Combitube during general anaesthesia: assessing complications in 540 patients
Keywords:
Combitube, ETC, general anaesthesia, complications
Abstract
Background: The esophageal-tracheal Combitube (ETC) was developed for the management of difficult airways but can also be used for general anaesthesia.
Methods: This clinical study collected data from patients undergoing anaesthesia with the ETC in order to assess the rate of complications.
Results: Five hundred forty patients were ventilated with the ETC. In 94.8% (512/540), insertion was performed for the first time by the respective physician. The following minor complications were observed: 38.7% sore throat, 30.9% blood on tube as sign of mucosal lesions and 17.0% cyanotic tongue. Experience decreased the risk of mucosal lesions (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.5–3.5). A higher than recommended volume of the oropharyngeal cuff was associated with blood on the ETC (OR: 1.5, 95% CI: 1.0–2.3) and tongue cyanosis (OR: 2.3, 95% CI: 1.4–3.7). Ventilation for more than 2 h was associated with tongue cyanosis (OR: 2.2, 95% CI: 1.6–3.1) and tongue protrusion (OR: 1.4, 95% CI: 1.1–1.9).
Conclusion: We conclude that the Combitube may be used for short procedures requiring general anaesthesia, but the high rate of minor complications limits its value when other alternatives such as a laryngeal mask airway are available. The tested method appears safe regarding major complications, but minor complications are common. Adherence to recommended cuff volumes, experience with the ETC and limiting its use to surgeries lasting less than 2 h might reduce the rate of complications.
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References
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6. Chen X, Jiao J, Cong X, Liu L, Wu X. A comparison of the performance of the I-gel vs. the LMA-S during anesthesia: a meta-analysis of randomized controlled trials. PLoS One. 2013;8:e71910. doi: 10.1371/journal.pone.0071910
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9. Gaitini LA, Vaida SJ, Mostafa S, Yanovski B, Croitoru M, Capdevila MD, et al. The Combitube in elective surgery: a report of 200 cases. Anesthesiology. 2001;94:79–82. doi: 10.1097/00000542-200101000-00016
10. Gaitini LA, Yanovsky B, Somri M, Tome R, Mora PC, Frass M, et al. Prospective randomized comparison of the EasyTube and the esophageal-tracheal Combitube airway devices during general anesthesia with mechanical ventilation. J Clin Anesth. 2011;23:475–81. doi: 10.1016/j.jclinane.2011.01.007
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13. Bishop MJ, Kharasch ED. Is the Combitube a useful emergency airway device for anesthesiologists? Anesth Analg. 1998;86:1141–2. doi: 10.1213/00000539-199805000-00045
14. Gaitini LA, Vaida SJ, Somri M, Fradis M, Ben-David B. Fiberoptic-guided airway exchange of the esophageal-tracheal Combitube in spontaneously breathing versus mechanically ventilated patients. Anesth Analg. 1999;88:193–6. doi: 10.1213/00000539-199901000-00036
15. Frass M, Johnson JC, Atherton GL, Fruhwald FX, Traindl O, Schwaighofer B, et al. Esophageal tracheal combitube (ETC) for emergency intubation: anatomical evaluation of ETC placement by radiography. Resuscitation. 1989;18:95–102. doi: 10.1016/0300-9572(89)90116-0
16. Frass M, Salem MR, Vaida S, Hagberg C. Esophageal-tracheal double- lumen airways. In: Hagberg C, Gabel J, eds. Benumof and Hagberg’s airway management. 3rd ed. Amsterdam: Elsevier Saunders; 2013, pp. 569–91.
17. Rabitsch W, Krafft P, Lackner FX, Frenzer R, Hofbauer R, Sherif C, et al. Evaluation of the oesophageal-tracheal double-lumen tube (Combitube) during general anaesthesia. Wien Klin Wochenschr. 2004;116:90–3. doi: 10.1007/BF03040702
18. Bein B, Carstensen S, Gleim M, Claus L, Tonner PH, Steinfath M, et al. A comparison of the proseal laryngeal mask airway, the laryngeal tube S and the oesophageal-tracheal combitube during routine surgical procedures. Eur J Anaesthesiol. 2005;22:341–6. doi: 10.1017/S026502150500058X
19. Oczenski W, Krenn H, Dahaba AA, Binder M, El-Schahawi-Kienzl I, Kohout S, et al. Complications following the use of the Combitube, tracheal tube and laryngeal mask airway. Anaesthesia. 1999;54:1161–5. doi: 10.1046/j.1365-2044.1999.01107.x
20. Sethi AK, Desai M, Tyagi A, Kumar S. Comparison of combitube, easy tube and tracheal tube for general anesthesia. J Anaesthesiol Clin Pharmacol. 2014;30:526–32. doi: 10.4103/0970-9185.142849
21. Vezina MC, Trepanier CA, Nicole PC, Lessard MR. Complications associated with the Esophageal-Tracheal Combitube in the pre-hospital setting. Can J Anaesth. 2007;54:124–8. doi: 10.1007/BF03022008
22. Eldor J, Ofek B, Abramowitz HB. Perforation of oesophagus by tracheal tube during resuscitation. Anaesthesia. 1990;45:70–1. doi: 10.1111/j.1365-2044.1990.tb14539.x
23. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32:429–34. doi: 10.1007/BF03011357
24. Urtubia RM, Aguila CM, Cumsille MA. Combitube: a study for proper use. Anesth Analg. 2000;90:958–62. doi: 10.1213/00000539-200004000-00034
25. Walz R, Davis S, Panning B. Is the Combitube a useful emergency airway device for anesthesiologists? Anesth Analg. 1999;88:233. doi: 10.1213/00000539-199901000-00056
26. Krafft P, Nikolic A, Frass M. Esophageal rupture associated with the use of the Combitube. Anesth Analg. 1998;87:1457. doi: 10.1213/00000539-199812000-00059
27. Levitan RM, Frass M. The Combitube as rescue device: recommended use of the small adult size for all patients six feet tall or shorter. Ann Emerg Med. 2004;44:92; author reply 92–3. doi: 10.1016/j.annemergmed.2003.12.034
28. Frass M, Urtubia RM, Hagberg CA. The Combitube: Esophageal-Tracheal Double-Lumen Airway. In Benumof’s Airway Management. Elsevier; 2007, pp. 594–615.
29. Bagheri SC, Stockmaster N, Delgado G, Kademani D, Carter TG, Ramzy A, et al. Esophageal rupture with the use of the Combitube: report of a case and review of the literature. J Oral Maxillofac Surg. 2008;66:1041–4. doi: 10.1016/j.joms.2007.08.009
30. Frass M, Frenzer R, Mayer G, Popovic R, Leithner C. Mechanical ventilation with the esophageal tracheal combitube (ETC) in the intensive care unit. Arch Emerg Med. 1987;4:219–25. doi: 10.1136/emj.4.4.219
31. Tanigawa K, Shigematsu A. Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan. Prehospital Emerg Care. 1998;2:96–100. doi: 10.1080/10903129808958850
32. Mercer MH, Gabbott DA. The influence of neck position on ventilation using the Combitube airway. Anaesthesia. 1998;53:146–50. doi: 10.1046/j.1365-2044.1998.00302.x
33. Keller C, Brimacombe J, Boehler M, Loeckinger A, Puehringer F. The influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures with the esophageal tracheal combitube. Anesthesiology. 2002;96:1074–7. doi: 10.1097/00000542-200205000-00008
34. Urtubia RM, Medina J. The Combitube should be redesigned for anaesthetic use. Anaesthesia. 2001;56:275. doi: 10.1046/j.1365-2044.2001.01918-5.x
35. Vezina D, Trepanier CA, Lessard MR, Bussieres J. Esophageal and tracheal distortion by the esophageal-tracheal Combitube: a cadaver study. Can J Anaesth. 1999;46:393–7. doi: 10.1007/BF03013236
36. Rumball CJ, MacDonald D. The PTL, Combitube, laryngeal mask, and oral airway: a randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care. 1997;1:1–10. doi: 10.1080/10903129708958776
2. Frass M, Frenzer R, Rauscha F, Schuster E, Glogar D. Ventilation with the esophageal tracheal combitube in cardiopulmonary resuscitation. Promptness and effectiveness. Chest. 1988;93:781–4. doi: 10.1378/chest.93.4.781
3. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–70. doi: 10.1097/ALN.0b013e31827773b2
4. Baidya DK, Chandralekha, Darlong V, Pandey R, Maitra S, Khanna P. Comparative efficacy and safety of the Ambu((R)) AuraOnce() laryngeal mask airway during general anaesthesia in adults: a systematic review and meta-analysis. Anaesthesia. 2014;69:1023–32. doi: 10.1111/anae.12682
5. Wong DT, Yang JJ, Jagannathan N. Brief review: the LMA supreme supraglottic airway. Can J Anaesth. 2012;59:483–93. doi: 10.1007/s12630-012-9673-0
6. Chen X, Jiao J, Cong X, Liu L, Wu X. A comparison of the performance of the I-gel vs. the LMA-S during anesthesia: a meta-analysis of randomized controlled trials. PLoS One. 2013;8:e71910. doi: 10.1371/journal.pone.0071910
7. Hosseinzadeh H, Golzari SE, Torabi E, Dehdilani M. hemodynamic changes following anesthesia induction and LMA insertion with propofol, etomidate, and propofol + etomidate. J Cardiovasc Thorac Res. 2013;5:109–12.
8. Sinha A, Jayaraman L, Punhani D. ProSeal LMA increases safe apnea period in morbidly obese patients undergoing surgery under general anesthesia. Obes Surg. 2013;23:580–4. doi: 10.1007/s11695-012-0833-7
9. Gaitini LA, Vaida SJ, Mostafa S, Yanovski B, Croitoru M, Capdevila MD, et al. The Combitube in elective surgery: a report of 200 cases. Anesthesiology. 2001;94:79–82. doi: 10.1097/00000542-200101000-00016
10. Gaitini LA, Yanovsky B, Somri M, Tome R, Mora PC, Frass M, et al. Prospective randomized comparison of the EasyTube and the esophageal-tracheal Combitube airway devices during general anesthesia with mechanical ventilation. J Clin Anesth. 2011;23:475–81. doi: 10.1016/j.jclinane.2011.01.007
11. Agro F, Frass M, Benumof J, Krafft P, Urtubia R, Gaitini L, et al. The esophageal tracheal combitube as a non-invasive alternative to endotracheal intubation. A review. Minerva Anestesiol. 2001;67:863–74.
12. Hartmann T, Krenn CG, Zoeggeler A, Hoerauf K, Benumof JL, Krafft P. The oesophageal-tracheal Combitube small adult. Anaesthesia. 2000;55:670–5. doi: 10.1046/j.1365-2044.2000.01376.x
13. Bishop MJ, Kharasch ED. Is the Combitube a useful emergency airway device for anesthesiologists? Anesth Analg. 1998;86:1141–2. doi: 10.1213/00000539-199805000-00045
14. Gaitini LA, Vaida SJ, Somri M, Fradis M, Ben-David B. Fiberoptic-guided airway exchange of the esophageal-tracheal Combitube in spontaneously breathing versus mechanically ventilated patients. Anesth Analg. 1999;88:193–6. doi: 10.1213/00000539-199901000-00036
15. Frass M, Johnson JC, Atherton GL, Fruhwald FX, Traindl O, Schwaighofer B, et al. Esophageal tracheal combitube (ETC) for emergency intubation: anatomical evaluation of ETC placement by radiography. Resuscitation. 1989;18:95–102. doi: 10.1016/0300-9572(89)90116-0
16. Frass M, Salem MR, Vaida S, Hagberg C. Esophageal-tracheal double- lumen airways. In: Hagberg C, Gabel J, eds. Benumof and Hagberg’s airway management. 3rd ed. Amsterdam: Elsevier Saunders; 2013, pp. 569–91.
17. Rabitsch W, Krafft P, Lackner FX, Frenzer R, Hofbauer R, Sherif C, et al. Evaluation of the oesophageal-tracheal double-lumen tube (Combitube) during general anaesthesia. Wien Klin Wochenschr. 2004;116:90–3. doi: 10.1007/BF03040702
18. Bein B, Carstensen S, Gleim M, Claus L, Tonner PH, Steinfath M, et al. A comparison of the proseal laryngeal mask airway, the laryngeal tube S and the oesophageal-tracheal combitube during routine surgical procedures. Eur J Anaesthesiol. 2005;22:341–6. doi: 10.1017/S026502150500058X
19. Oczenski W, Krenn H, Dahaba AA, Binder M, El-Schahawi-Kienzl I, Kohout S, et al. Complications following the use of the Combitube, tracheal tube and laryngeal mask airway. Anaesthesia. 1999;54:1161–5. doi: 10.1046/j.1365-2044.1999.01107.x
20. Sethi AK, Desai M, Tyagi A, Kumar S. Comparison of combitube, easy tube and tracheal tube for general anesthesia. J Anaesthesiol Clin Pharmacol. 2014;30:526–32. doi: 10.4103/0970-9185.142849
21. Vezina MC, Trepanier CA, Nicole PC, Lessard MR. Complications associated with the Esophageal-Tracheal Combitube in the pre-hospital setting. Can J Anaesth. 2007;54:124–8. doi: 10.1007/BF03022008
22. Eldor J, Ofek B, Abramowitz HB. Perforation of oesophagus by tracheal tube during resuscitation. Anaesthesia. 1990;45:70–1. doi: 10.1111/j.1365-2044.1990.tb14539.x
23. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32:429–34. doi: 10.1007/BF03011357
24. Urtubia RM, Aguila CM, Cumsille MA. Combitube: a study for proper use. Anesth Analg. 2000;90:958–62. doi: 10.1213/00000539-200004000-00034
25. Walz R, Davis S, Panning B. Is the Combitube a useful emergency airway device for anesthesiologists? Anesth Analg. 1999;88:233. doi: 10.1213/00000539-199901000-00056
26. Krafft P, Nikolic A, Frass M. Esophageal rupture associated with the use of the Combitube. Anesth Analg. 1998;87:1457. doi: 10.1213/00000539-199812000-00059
27. Levitan RM, Frass M. The Combitube as rescue device: recommended use of the small adult size for all patients six feet tall or shorter. Ann Emerg Med. 2004;44:92; author reply 92–3. doi: 10.1016/j.annemergmed.2003.12.034
28. Frass M, Urtubia RM, Hagberg CA. The Combitube: Esophageal-Tracheal Double-Lumen Airway. In Benumof’s Airway Management. Elsevier; 2007, pp. 594–615.
29. Bagheri SC, Stockmaster N, Delgado G, Kademani D, Carter TG, Ramzy A, et al. Esophageal rupture with the use of the Combitube: report of a case and review of the literature. J Oral Maxillofac Surg. 2008;66:1041–4. doi: 10.1016/j.joms.2007.08.009
30. Frass M, Frenzer R, Mayer G, Popovic R, Leithner C. Mechanical ventilation with the esophageal tracheal combitube (ETC) in the intensive care unit. Arch Emerg Med. 1987;4:219–25. doi: 10.1136/emj.4.4.219
31. Tanigawa K, Shigematsu A. Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan. Prehospital Emerg Care. 1998;2:96–100. doi: 10.1080/10903129808958850
32. Mercer MH, Gabbott DA. The influence of neck position on ventilation using the Combitube airway. Anaesthesia. 1998;53:146–50. doi: 10.1046/j.1365-2044.1998.00302.x
33. Keller C, Brimacombe J, Boehler M, Loeckinger A, Puehringer F. The influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures with the esophageal tracheal combitube. Anesthesiology. 2002;96:1074–7. doi: 10.1097/00000542-200205000-00008
34. Urtubia RM, Medina J. The Combitube should be redesigned for anaesthetic use. Anaesthesia. 2001;56:275. doi: 10.1046/j.1365-2044.2001.01918-5.x
35. Vezina D, Trepanier CA, Lessard MR, Bussieres J. Esophageal and tracheal distortion by the esophageal-tracheal Combitube: a cadaver study. Can J Anaesth. 1999;46:393–7. doi: 10.1007/BF03013236
36. Rumball CJ, MacDonald D. The PTL, Combitube, laryngeal mask, and oral airway: a randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care. 1997;1:1–10. doi: 10.1080/10903129708958776
Published
2023-04-21
How to Cite
Harrison N., Pajenda S., Szarpak L., Buschsieweke A.-M., Somri M., Frass M., Panning B., & Robak O. (2023). Ventilation with the esophageal-tracheal Combitube during general anaesthesia: assessing complications in 540 patients. Upsala Journal of Medical Sciences, 128(1). https://doi.org/10.48101/ujms.v128.9212
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