Advertisement

The Role of the Combitube and Laryngeal Tube

  • Michael Woo
  • Michael F. O’Connor
Chapter

Abstract

First described in 1987 [1], the Combitube combines the lumen of an endotracheal tube with an esophageal obturator airway. The dual lumen design facilitates airway management for the skilled or novice operator. Like a conventional endotracheal tube, it can be inserted into the trachea blindly or using direct laryngoscopy. Like an esophageal obturator or LMA, it can also be introduced blindly. If the Combitube resides in the esophagus, the obturator (blue) lumen can be used to ventilate the patient. The number of attempts to successful placement should be minimized since ventilation is possible whether the device is placed in the esophagus or trachea. The structural features of the esophageal-tracheal Combitube (ETC) are detailed in Fig. 12.1.

Keywords

Esophageal Perforation Subcutaneous Emphysema Flexible Bronchoscope Lateral Placement Laryngeal Tube 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Frass M, Frenzer R, Zdrahal F, et al. The esophageal tracheal combitube preliminary results with a new airway for CPR. Ann Emerg Med. 1987;16:768–72.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    Tanigawa K, Shigematsu A. Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan. Prehosp Emerg Care. 1998;2:96–100.PubMedCrossRefGoogle Scholar
  4. 4.
    Russi Christopher S, Lonny M, Hartley MJ. A Comparison of the King-LT to endotracheal intubation and combitube in a simulated difficult airway. Prehosp Emerg Care. 2008;12(1):35–41.PubMedCrossRefGoogle Scholar
  5. 5.
    American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.1: Adjuncts for Airway Control and Ventilation Circulation, Dec 2005; 112: IV-51 - IV-57.Google Scholar
  6. 6.
    http://www.asahq.org/For-Members/Practice-Management/Practice-Parameters.aspx#airway. Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2003; 98:1269–77.Google Scholar
  7. 7.
    Zamora JE, Saha TK. Combitube rescue for Cesarean delivery followed by ninth and twelfth cranial nerve dysfunction. Can J Anaesth. 2008;55(11):779–84.PubMedCrossRefGoogle Scholar
  8. 8.
    Frass M, Frenzer R, Mayer G, Popovic R, Leithner C. Mechanical ventilation with the esophageal tracheal combitube (ETC) in the intensive care unit. Emerg Med J. 1987;4:219–25.CrossRefGoogle Scholar
  9. 9.
    Richards C. Piriform sinus perforation during esophageal-tracheal combitube placement. J Emerg Med. 1998;16(1):37–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Gaitini Luis A, Vaida Sonia J, Somri M, et al. The combitube in elective surgery: a report of 200 cases. Anesthesiology. 2001;94:79–82.CrossRefGoogle Scholar
  11. 11.
    Vézina D, Lessard MR, Bussières J, Topping C, Trépanier CA. Complications associated with the use of the esophageal-tracheal combitube. Can J Anaesth. 1998;45(1):76–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Mercer MH, Gabbott DA. The influence of neck position on ventilation using the combitube airway. Anaesthesia. 1998;53:146–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Urtubia RM, Frass M, Staudinger T, Krafft P. Modification of the Lipp maneuver for blind insertion of the Esophageal-Tracheal Combitube. Can J Anaesth. 2005;52(2):216–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Gaitini LA, et al. Minimal inflation volume for combitube oropharyngeal balloon. J Med Ar. 2010;8(3):27–32.Google Scholar
  15. 15.
    Ahmed SM, Rizvi KA, Khan RM, Zafar MU, Nadeem A. Less tongue engorgement with lateral placement of the Esophageal Tracheal Combitube. Acta Anaesthesiol Scand. 2008;52(6):834–7. Epub 2008 May 19.PubMedCrossRefGoogle Scholar
  16. 16.
    Rabitisch W, Kolster WJ, Burgmann H, et al. Recommendation of the minimal volume technique to avoid tongue engorgement with prolonged use of the Esophageal-Tracheal Combitube. Ann Emerg Med. 2005;45(5):565–6. author reply.CrossRefGoogle Scholar
  17. 17.
    Urtubia RM, Aguila CM, Cumsille MA. Combitube®: a study for proper use. Anesth Analg. 2000;90:958–62.PubMedCrossRefGoogle Scholar
  18. 18.
    Zamora JE, Saha TK. Combitube rescue for Cesarean delivery followed by ninth and twelfth cranial nerve dysfunction. Can J Anaesth. 2008;55(11):779–84.PubMedCrossRefGoogle Scholar
  19. 19.
    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(5):1041–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Klein H, Williamson M, Sue-Ling HM, et al. Esophageal rupture associated with the use of the Combitube™. Anesth Analg. 1997;85:937–9.PubMedGoogle Scholar
  21. 21.
    Richards C. Piriform sinus perforation during esophageal-tracheal combitube placement. J Emerg Med. 1998;16(1):37–9.PubMedCrossRefGoogle Scholar
  22. 22.
    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(6):475–81.PubMedCrossRefGoogle Scholar
  23. 23.
  24. 24.
    Roland W, Shawn D, Bernhard P. Is the Combitube® a useful emergency airway device for anesthesiologists? Anesth Analg. 1999;88(1):233.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Anesthesia & Critical CareThe University of ChicagoChicagoUSA

Personalised recommendations