Methods of intra-operative airway exchange

Abstract

<p>In patients requiring an intra-operative airway exchange, does the use of a CAEC allow for safer, more effective airway exchange compared to a GEB?</p> <p>One of the biggest benefits of the CAEC is its ability to provide oxygenation to the patient throughout the ETT exchange via jet ventilation. However, this oxygen and pressure can create a one-way valve, resulting in a pneumothorax and potentially leading to cardiovascular collapse. The rate of pneumothorax with a CAEC is up to 11%. In order to prevent this, CAECs with jet ventilation should not be used with patients who are at an increased risk for a pneumothorax or those who would not be able to tolerate this complication. Additionally, if a CAEC passes through the Murphy&rsquo;s eye of the ETT it can cause tracheal laceration, perforation, or pneumothorax. Overall failure of ETT exchange with CAECs is 13.8%.</p> <p>Complications also exist with GEBs and are most often seen with aggressive or blind placement. In fact, only 0.8 Newton power can result in airway trauma. Complications seen with GEBs include tracheal injury, bleeding, abrasions, perforations, pneumothoraxes, and tracheal rupture. Lubrication should be applied to the GEB, and it should be advanced slowly to mitigate these complications. Additionally, the angled tip of the GEB should face anteriorly and it should not be advanced past 22 cm past the incisors. One of the biggest problems with using a GEB is its length relative to the ETT. When removing the ETT, the length of the GEB can become lost in the ETT and oral cavity, causing the anesthetist to lose control of the GEB. In order to solve this problem, the in situ and new ETT can be cut to 24-26 cm to allow continuous control over the GEB.</p>