|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 96-97
An alternate way of fixing endotracheal tube during cleft lip and cleft palate surgery in children
Sudhansu Sekhar Nayak1, Ankur Khandelwal2, Badri Prasad Das3
1 Department of Anaesthesiology, ABVIMS and RML Hospital, New Delhi, India
2 Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India
3 Department of Anaesthesiology and Critical Care, IMS, BHU, Varanasi, Uttar Pradesh, India
|Date of Submission||19-May-2022|
|Date of Acceptance||03-Jul-2022|
|Date of Web Publication||08-Aug-2022|
Dr. Sudhansu Sekhar Nayak
Department of Anaesthesiology, ABVIMS and RML Hospital, New Delhi - 110 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nayak SS, Khandelwal A, Das BP. An alternate way of fixing endotracheal tube during cleft lip and cleft palate surgery in children. Airway 2022;5:96-7
|How to cite this URL:|
Nayak SS, Khandelwal A, Das BP. An alternate way of fixing endotracheal tube during cleft lip and cleft palate surgery in children. Airway [serial online] 2022 [cited 2022 Sep 28];5:96-7. Available from: https://www.arwy.org/text.asp?2022/5/2/96/353565
During cleft palate surgery, surgeons use a mouth gag that keeps both the tongue and endotracheal tube (ETT) in the midline, providing adequate space for surgery. A strong, midline fixation of ETT that prevents lateral displacement of the ETT is very crucial for providing surgical comfort and good outcomes. Different methods of tube fixation that have been tried include conventional tube fixation by adhesive tape, surgical suture, using a K-wire to anchor the ETT to the teeth, using a transparent adhesive dressing (such as Tegaderm™) or using a 3-point fixation using an elastic adhesive tape (such as Dynaplast™). Central fixation is often difficult. We have tried to overcome this problem by designing a new technique which is simple, easy and uniformly fits the tube without lateral displacement.
We designed a fixation method using an elastic adhesive tape (Dynaplast™) approximately 5 cm in breadth and 10 cm in length. This adhesive tape was cut into five phalanges approximately 1 cm wide and running 6 cm along the length, leaving a 4 cm undivided broad section [Figure 1]. The two outermost and middle phalanges were then removed making it a bifid phalange fixator with a broad base [Figure 2]. The undivided base was fixed below the lower border of the lower lip (from the chin up to the vermilion border of the lower lip, taking care to avoid the lip). The uncut second and fourth phalanges were wound firmly around the ETT with the end terminating on either side below the angle of the mouth [Figure 3] and [Figure 4]. The ETT is accommodated in the space provided by the cut middle phalange. This fixation not only prevents lateral movements of the ETT but also provides firm fixation in the centre even when the mouth gag is opened by the surgeon. This fixation also keeps the tongue in the midline, providing maximum space for surgery.
|Figure 2: The outermost phalanges and the middle phalange are removed making it a bifid adhesive fixator|
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|Figure 3: The undivided base is fixed below the vermilion border of the lower lip and the second and fourth phalanges wound around the endotracheal tube with the end terminating beyond the angle of the mouth (anterior view)|
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|Figure 4: The undivided base is fixed below the vermilion border of the lower lip and the second and fourth phalanges wound around the endotracheal tube with the end terminating beyond the angle of the mouth (lateral view)|
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This method differs from the conventional way of fixation where a single tape is used to fix the ETT leading to possibility of movement of the tube on either side away from the midline. Our method prevents untoward lateral movement of the ETT. It fixes the tube firmly in the midline providing excellent and unhindered surgical access to the surgeon. In addition, firm fixation of the ETT also gives the anaesthesiologist the confidence of a secure airway, especially when access to the airway is limited once surgery begins. Our method is simple, easy and convenient. It keeps the tube fixed firmly to the chin and prevents lateral displacement. We have found this method very useful. It has therefore become the favoured method of fixation in our institution by surgeons and anaesthesiologists alike for cleft palate surgery in children.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that the name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Xue FS, Liao X, Xu YC. Orotracheal tube fixation in children undergoing cleft lip and palate surgery. Can J Anaesth 2008;55:791-3.
Kapoor D, Singh S, Sharma D. A novel technique for orotracheal tube fixation in children undergoing cleft lip and palate surgery. Acta Anaesthesiol Taiwan 2011;49:37-8.
Agarwal S, Gupta D, Agarwal A. A new technique for midline orotracheal tube fixation. Can J Anaesth 2008;55:390-1.
Bajaj SP, Chavan N, Sharma A. Easy method of centralized fixation of endotracheal tube in cleft lip and palate surgery. Indian J Plast Surg 2012;45:138-9.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]