Anesthetic management of a patient with Montgomery t-tube in-situ for direct laryngoscopy

Abstract

The Montgomery silicone t-tube used for post-procedural tracheal stenosis has advantage of acting as both stent and tracheostomy tube. The anesthetic management of patient with t-tube in situ poses a challenge. Safe management of such patients requires careful planning. We describe anesthetic management for direct laryngoscopy of a patient with t-tube in situ.

Humble Foley's catheter to the rescue in a case of T-tube insertion: a case report

“…This is because of loss of anesthetic gases through the open proximal end of the vertical limb and that T-tubes do not come with standard anesthesia circuit connectors. Various methods for management of the above problems have been described [ 3 4 , 5 , 6 ].…”

Anesthesia in a patient with Montgomery tube in situ: difficult to easy!

“…Use of 100% oxygen prevented desaturation during 90 seconds of complete lumen occlusion in one of our cases. Topical anesthesia has been suggested to decrease the requirement of anesthesia and facilitate direct laryngoscopy in a patient with a T‐tube in situ . The presence of the fiberscope in the trachea allows the administration of local anesthetic under direct vision by SAYGO (Spray as you go) technique, thus, allowing a decrease in the requirement of intravenous anesthetic agents.…”

Anesthetic management of T tube: A simple approach

“…[1] This appears to be technically difficult in view of considerable loss of gases through the open laryngeal end of the intraluminal limb. An appropriate sized red rubber suction catheter inserted trans-laryngeally into the open intraluminal limb could have hastened the process of induction.…”