To the Editor:-The American Society of Anesthesiologists Task Force on Management of the Difficult Airway have made recommendations for an extubation strategy after difficult endotracheal intubation. [1]One of the components of this strategy involves the “short-term use of a device that can serve as a guide for expedited reintubation.” Jet stylets, tube exchangers, and even fiberoptic bronchoscopes have all been used for this purpose. [2,3]These instruments, however, are not always available, may be somewhat cumbersome to use, and may not be easily tolerated by the awakening patient.
I would like to describe a technique that has given me increased confidence with extubation of the difficult airway. Before extubation, I pass a modified 6-French, 80-cm Fogarty arterial embolectomy catheter down the endotracheal tube. I then remove the endotracheal tube over the catheter, leaving the catheter in place (Figure 1). The Fogarty catheter is modified by cutting off the Luer-lock syringe connector. The catheter is extremely well tolerated, both orally and nasally, and may be left in place for some considerable time. (I have used the device on four occasions and no patient to date has even remarked on its presence.) If rapid reintubation proves to be necessary, the catheter is rigid enough to act as a stent for an endotracheal tube or tube exchanger. This technique is not a panacea for all situations of this type, and there is no reason to believe that it is immune to problems any more than all the others. However, with selective use, I believe it to be a valuable aid to extubation of the difficult airway.
Glynne D. Stanley, M.D., F.R.C.A.
Assistant Professor of Anesthesiology; Boston University Medical Center; Boston, Massachusetts
(Accepted for publication September 17, 1998.)
