Correspondence
1001
Fixation of the laryngeal mask airway There is a small problem when the laryngeal mask airway (LMA) is used. A satisfactory method to secure position of the LMA is required and the ‘Tracheal Tube Holder’ (TTH) manufacturered by Portex, Hythe, seems ideal. The device supports the LMA firmly over a length of some 8 cm and prevents it from movement or kinking under the weight of the anaesthetic tubing. The bite block prevents compression of the tube between the teeth during recovery and facilitates removal at this stage. Use of a bite block is recommended by the manufacturer of the LMA.‘ This combination of fixation and bite block represents an advantage over the fibrescope protector described by Dr Marks (Anaesthesia 1990; 45: 259). The TTH is easily inserted after the LMA is satisfactorily positioned. It is
placed in the opposite side of the mouth from the LMA and is held open while the two are slid together. The two can then be slipped apart during recovery and the TTH kept in place while the LMA is removed. The device costs less than f5 and is re-usable afker cleaning. Bangour General Hospital, By Broxburn, West Lothian
M.H. WORSLEY C.C.M. HOWIE
Reference 1. BRAINAIJ, SIMMONVS D. Using the intravent laryngeal mask. Product information sheet. 1989 Colgate Medical
Fig, 1.
Attachments to double lumen bronchial tubes We would like to report a novel arrangement of ventilator tubing for attachment to a double lumen bronchial tube in order to prevent soiling from one lumen to another and to avoid an increase in the deadspace of the system. A woman in her 40s with past history of arteriovenous malformations (AVMs) affecting both kidneys was referred to the cardiothoracic service in respiratory failure after a massive haemoptysis. Chest X ray showed unilateral lesions
on the right side which were presumed to be further AVMs in the lung. It was decided to isolate the affected bronchus to prevent further soiling of the relatively healthy left lung, so a double lumen bronchial tube was passed. Unfortunately, in view of continued massive bleeding from the right lung, the left bronchial system was still at risk from contamination by blood which reached as far proximally as the catheter mount. An extra set of ventilator
Fig. 1. The layout of ventilator tubing is shown with the inspiratory system in black, and the expiratory system in white.
1001
Fixation of the laryngeal mask airway There is a small problem when the laryngeal mask airway (LMA) is used. A satisfactory method to secure position of the LMA is required and the ‘Tracheal Tube Holder’ (TTH) manufacturered by Portex, Hythe, seems ideal. The device supports the LMA firmly over a length of some 8 cm and prevents it from movement or kinking under the weight of the anaesthetic tubing. The bite block prevents compression of the tube between the teeth during recovery and facilitates removal at this stage. Use of a bite block is recommended by the manufacturer of the LMA.‘ This combination of fixation and bite block represents an advantage over the fibrescope protector described by Dr Marks (Anaesthesia 1990; 45: 259). The TTH is easily inserted after the LMA is satisfactorily positioned. It is
placed in the opposite side of the mouth from the LMA and is held open while the two are slid together. The two can then be slipped apart during recovery and the TTH kept in place while the LMA is removed. The device costs less than f5 and is re-usable afker cleaning. Bangour General Hospital, By Broxburn, West Lothian
M.H. WORSLEY C.C.M. HOWIE
Reference 1. BRAINAIJ, SIMMONVS D. Using the intravent laryngeal mask. Product information sheet. 1989 Colgate Medical
Fig, 1.
Attachments to double lumen bronchial tubes We would like to report a novel arrangement of ventilator tubing for attachment to a double lumen bronchial tube in order to prevent soiling from one lumen to another and to avoid an increase in the deadspace of the system. A woman in her 40s with past history of arteriovenous malformations (AVMs) affecting both kidneys was referred to the cardiothoracic service in respiratory failure after a massive haemoptysis. Chest X ray showed unilateral lesions
on the right side which were presumed to be further AVMs in the lung. It was decided to isolate the affected bronchus to prevent further soiling of the relatively healthy left lung, so a double lumen bronchial tube was passed. Unfortunately, in view of continued massive bleeding from the right lung, the left bronchial system was still at risk from contamination by blood which reached as far proximally as the catheter mount. An extra set of ventilator
Fig. 1. The layout of ventilator tubing is shown with the inspiratory system in black, and the expiratory system in white.
