The Combitube in Elective Surgery

Gaitini, Luis; Vaida, Sonia; Somri, Mostafa; Yanovski, Boris; Croitoru, M.; Capdevila, Marisa; Sabo, Edmond; Ben‐David, Bruce; Benumof, Jonathan L.

doi:10.1097/00000542-200101000-00016

Cited by 66 publications

(43 citation statements)

References 6 publications

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“…6 However, its routine use for the airway management during general anesthesia has been suggested. [7][8][9] Many serious complications, including but not limited to aspiration pneumonitis, pneumothorax, pneumomediastinum, airway injuries, esophageal lacerations and perforations have been reported with the Combitube. 6,10,11 However, limited data on the incidence and severity of these complications are available, in spite of its widespread acceptance in the pre-hospital setting.…”

Section: Discussionmentioning

confidence: 99%

Complications associated with the Esophageal-Tracheal Combitube® in the pre-hospital setting

Vézina

Trépanier

Nicole

et al. 2007

Can J Anesth/J Can Anesth

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Purpose:The Esophageal-Tracheal Combitube® (Combitube) is widely used for the management of the airway during cardiopulmonary resuscitation in the pre-hospital setting. Although serious complications have been reported with the Combitube, there is a paucity of data relative to the frequency and nature of such complications. The objective of this retrospective study was to determine the incidence and the nature of complications associated to the Combitube in the pre-hospital setting.Methods: Since 1993, in the Quebec City Health Region, the basic life support treatment algorithm for emergency medical technicians has included the use of a Combitube as the primary airway device for management of all patients presenting with cardiac or respiratory arrest. The database of the emergency coordination services was searched for the period between 1993 and 2003 (2,981 patients). Only those patients who survived at least 12 hr were included. Medical records of these patients were reviewed to identify complications related to the use of the Combitube.Results: Two-hundred-eighty (280) patients were identified. Fifty-eight (58) patients (20.7%, confidence interval (CI) 95% = 16.0%-25.4%) presented 69 complications: aspiration pneumonitis (n = 31), pulmonary aspiration (n = 16), pneumothorax (n = 6), upper airway bleeding (n = 4), esophageal laceration (n = 3), sc emphysema (n = 2), esophageal perforation and mediastinitis (n = 2), tongue edema (n = 2), vocal cord injury (n = 1), tracheal injury (n = 1), and pneumomediastinum (n = 1). Thirteen of these complications (12 patients, 4.3%, CI 95% = 2.0%-6.3%) were judged as most likely resulting from trauma associated with insertion of the Combitube. Conclusion:The use of the Combitube in the pre-hospital setting is associated with a notable incidence of serious complications. Résultats : patients ont été inclut. 7 %, intervalle de confiance (IC) 95 % = 16,0-25,4 %) ont présenté 69 complications : pneumonie d'aspiration (n = 31), aspiration bronchique (n = 16), pneumothorax (n = 6), saignement des voies aériennes supérieures (n = 4), lacérations oesophagiennes (n = 3), emphysème sc (n = 2), perforation oesophagienne et médiastinite (n = 2), oedème de la langue (n = 2), lésion aux cordes vocales (n = 1), lésion trachéale (n = 1), pneumomédiastin (n = 1). Treize de ces complications (12 patients,4,3 % 4,3 %, IC 95% = 2,[0][1][2][3][4][5][6]3 %)

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Section: Discussionmentioning

confidence: 99%

Complications associated with the Esophageal-Tracheal Combitube® in the pre-hospital setting

Vézina

Trépanier

Nicole

et al. 2007

Can J Anesth/J Can Anesth

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“…Gaitini et al 35 also described the use of the Combitube in elective surgery. Two hundred ASA physical status I and II patients underwent general anesthesia during elective surgery with either spontaneous ventilation (patients were not paralyzed, n ϭ 100) or mechanical ventilation (patients were paralyzed, n ϭ 100).…”

Section: Elective Surgerymentioning

confidence: 99%

Current status of the Combitube™: a review of the literature

Frass¹,

Benumof²,

Krafft³

2002

Journal of Clinical Anesthesia

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“…its elective use has been described for routine surgery 1 and for Cesarean delivery (CD) under general anesthesia. 2 it has also been shown to be useful as a rescue device for in-hospital airway management when the laryngeal mask airway (LMA) has failed.…”

Section: éLéments Cliniques : Une Femme De 24 Ans (G4 P1) (Poids 112mentioning

confidence: 99%

Combitube™ rescue for cesarean delivery followed by ninth and twelfth cranial nerve dysfunction

Zamora

Saha

2008

Can J Anesth/J Can Anesth

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Purpose:The Combitube™ has been shown to be effective in many airway management scenarios. We describe its use as a rescue device in a "cannot intubate cannot ventilate" (CICV) situation that was encountered during a Cesarean delivery (CD) followed by transient cranial nerve dysfunction. Clinical features:A 24-yr-old gravida 4 para 1 (weight 112 kg, body mass index 44 kg·m -2 ) at 34 weeks gestation, with pregnancy induced hypertension and a prior history of uneventful airway management, presented for urgent CD. She refused regional anesthesia and attempts at awake laryngoscopy and intubation. Following rapid sequence induction, attempts at direct laryngoscopy and intubation failed. Ventilation via facemask and laryngeal mask also failed. A Combitube was inserted and inflated according to manufacturer's instructions and resulted in successful ventilation of the patient. The Combitube was in place for approximately three hours and then removed uneventfully. The following day, the patient presented with signs and symptoms consistent with bilateral glossopharyngeal and unilateral hypoglossal nerve dysfunction. Three months later the patient's nerve dysfunction had completely resolved. Conclusion:Although this patient's transient nerve dysfunction was most likely due to the Combitube, we believe its inclusion as part of any difficult airway armamentarium should be encouraged. Training in its use should be promoted. It has an important role in emergency airway management and can be effective when other non-surgical ventilation techniques fail. Despite this, clinicians must remain vigilant for complications following its use. CAN J ANESTH 2008 / 55: 11 / pp 779-784

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The Combitube in Elective Surgery

Abstract: The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

Cited by 66 publications

References 6 publications

Complications associated with the Esophageal-Tracheal Combitube® in the pre-hospital setting

Complications associated with the Esophageal-Tracheal Combitube® in the pre-hospital setting

Current status of the Combitube™: a review of the literature

Combitube™ rescue for cesarean delivery followed by ninth and twelfth cranial nerve dysfunction

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