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LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 105-106

Microcuff versus uncuffed oral Ring-Adair-Elwyn tube: Is cuff the only difference?


Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission22-Jul-2020
Date of Acceptance07-Aug-2020
Date of Web Publication30-Aug-2020

Correspondence Address:
Dr. Meenupriya Arasu
Department of Anaesthesia and Critical Care, Institute Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ARWY.ARWY_28_20

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How to cite this article:
Rudingwa P, Arasu M, Panneerselvam S, Adaikkalavan G. Microcuff versus uncuffed oral Ring-Adair-Elwyn tube: Is cuff the only difference?. Airway 2020;3:105-6

How to cite this URL:
Rudingwa P, Arasu M, Panneerselvam S, Adaikkalavan G. Microcuff versus uncuffed oral Ring-Adair-Elwyn tube: Is cuff the only difference?. Airway [serial online] 2020 [cited 2020 Oct 19];3:105-6. Available from: https://www.arwy.org/text.asp?2020/3/2/105/293965



Cleft palate repair is a common surgical procedure performed in children less than 2 years of age. The airway is usually secured using an oral Ring-Adair-Elwyn (RAE) tube. The preformed curve of the oral RAE tube allows stable midline placement without encroaching on the surgical field and avoids kinking of the tube while placing the mouth gag. Conventional paediatric oral RAE tubes are uncuffed and associated with problems due to leakage around the tube, necessitating tube changes. With the advent of Microcuff tubes (Kimberly-Clark Corporation, Roswell, GA 30076, USA), these problems can be avoided keeping in mind certain features peculiar to these tubes.

It is important to note that when compared to an uncuffed oral RAE tube of similar internal diameter (ID), the Microcuff oral RAE tube is more acutely bent and has the preformed bend at a farther distance from the bevelled end [Figure 1] and [Table 1]. It also lacks a Murphy's eye. The farther located bend of the Microcuff oral RAE tube is designed such that a smaller size tube would be appropriate for a given age to accommodate the cuff.[1] The usual choice is to use an endotracheal tube (ETT) with the maximum feasible ID (preferably 4.5 mm ID in the age group of 1–2 years) to avoid leakage and reduce airway resistance. However, the size selection for Microcuff tubes is determined by Khine's recommendation up to 2 years as mentioned in the package.[2] The 3.5 mm ID Microcuff oral RAE tube with the bend at 12 cm would be the recommended size for 1–2 years of age, whereas using a conventionally chosen size of 4.5 mm ID Microcuff tube with the bend at 15 cm would lead to endobronchial intubation.[3] Coupled with the absence of the Murphy's eye, choosing an inappropriate size can result in a complete absence of ventilation to one lung if endobronchial intubation occurs. This aspect should be kept in mind during the size selection of Microcuff oral RAE tubes to avoid complications. Further studies with fibreoptic assessment are needed to evaluate the size selection of Microcuff oral RAE tubes in children concerning the actual tip position needed during cleft palate surgeries.
Figure 1: Microcuff oral Ring-Adair-Elwyn 4.5 mm internal diameter endotracheal tube with the bend at 15 cm (left) and uncuffed oral Ring-Adair-Elwyn 4.5 mm internal diameter endotracheal tube with the bend at 14 cm (right)

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Table 1: Distance of the preformed bend from the bevelled end in Microcuff oral Ring-Adair-Elwyn and uncuffed oral Ring-Adair-Elwyn tubes

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Weiss M, Dullenkopf A, Böttcher S, Schmitz A, Stutz K, Gysin C, et al. Clinical evaluation of cuff and tube tip position in a newly designed paediatric preformed oral cuffed tracheal tube. Br J Anaesth 2006;97:695-700.  Back to cited text no. 1
    
2.
Khine HH, Corddry DH, Kettrick RG, Martin TM, McCloskey JJ, Rose JB, et al. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology 1997;86:627-31.  Back to cited text no. 2
    
3.
Sugiyama K, Yokoyama K. Displacement of the endotracheal tube caused by change of head position in pediatric anesthesia: Evaluation by fiberoptic bronchoscopy. Anesth Analg 1996;82:251-3.  Back to cited text no. 3
    


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