A Bifurcated Endobronchial Tube in the Management of Laryngotracheo-Oesophageal Cleft Repair

Abstract

We describe the management of laryngotracheo-oesophageal cleft Type III using a bifurcated endobronchial tube. When the cleft was opened for repair, we were able to obtain effective control of the airway, which is the main problem in this rare congenital anomaly. Commercial tubes are not available, so we made the tube on the day of surgery, immediately before operation.

Anaesthetic management in a case of a type IV laryngotracheo‐oesophageal cleft

“…Following the same strategy, Lim et al (12) inserted two tracheal tubes, each one into a different main stem bronchus. Nowadays new models of bifurcated tubes have been developed (13,14).…”

Laryngotracheo‐oesophageal cleft in an infant: airway management during bronchoscopy

“…Successful anaesthetic management of patients with LTOC is based on early diagnosis with precise definition of the extent of the cleft determined at endoscopy (7,8) and establishment of a secure airway (4,8,9). Petterson classified LTOC as type I in which there is a posterior cleft involving the larynx, the interarytenoid muscles and the cricoid laminae; type II, in which the cleft extends up to the sixth tracheal ring (corresponding to the cervical trachea) and type III, where the cleft extends close to the carina (10).…”

“…Also, tracheostomy in an infant is difficult and has its own hazards. The tracheal tube is known to slip over the superior edge of the septum into the oesophagus (8,13,14). This is another reason in favour of the tracheostomy tube.…”

“…This is another reason in favour of the tracheostomy tube. Endobronchial tubes have been recommended for type III and IV LTOC (4,8,11). However, in our patient, the cleft did not reach the carina and thus endobronchial intubation was not considered.…”

“…Awake intubation (14) is associated with a greater number of attempts and a longer time for successful intubation, more severe and prolonged hypoxia and adverse effects of hypertensive response with risk of intracranial haemorrhage, besides trauma (18). The requirement of volatile anaesthetics to maintain adequate depth of anaesthesia on spontaneous ventilation (7,8,14) is higher and thus return of airway reflexes is delayed. We therefore do not recommend awake intubation or spontaneous respiration during anaesthesia.…”