COMPARISION BETWEEN RAE, FLEXOMETALLIC AND PVC MACINTOSH ENDOTRACHEAL TUBES USED IN CLEFT PALATE SURGERY
Authors: Agrawal A, Sharma MK, Agrawal S, Arora V, Somvanshi R.
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Introduction: Cleft lip/palate are the most common craniofacial anomalies in children, with an incidence of CLP worldwide is 1 in 700 live births. The risk factors are considered as Family history etc. Anaesthesia during cleft lip and palate surgery carries a high risk and difficult airway management in children. Because of other associated congenital anomalies, the anaesthetic management becomes more complicated. Flexometallic endotracheal tubes, PVC macintosh tube, RAE tube are have their own risks and benefits when compared with each other. This study was undertaken to compare ease of intubation ,ease of ventilation ,intra operative maintenance of respiratory parameters ,intra-operative airway complication, post extubation complication by using 3 different types of tubes (1) RAE (Ring Adair Elwyn) tube (2) flexometallic tube (3) PVC ( Polyvinyl Chloride) macintosh tube in pediatric cleft palate surgeries.
Material & Methods: A randomized controlled trial was conducted on 90 ASA I and ASA II pediatric patients of age group 9 month to 5 years undergoing cleft palate surgeries. Patients were randomly allocated in three groups of 30 each. Group 1: intubated with R A E endotracheal tube, Group 2:intubated with flexometallictube and Group 3: intubated with P V C macintosh endotracheal tube. The power of study on choosing such sample size was found to be at 90% level. Time taken for intubation, No. of attempt taken for intubation, Monitoring of capnography, SPO2, pulse rate and mean airway pressure every 15 minutes during the surgical procedures, Endobronchial intubation, Inadvertent extubation, Ease of passing of suction catheter after application of dingman retractor and Post extubation cough and croup was observed.
Results: The significant differences were observed in stylet used, ease of passing suction catheter and post extubation cough and heart rate after retractor among the groups (p<0.05). All other differences were found to be insignificant.
Conclusion: RAE tube provides a good approach for airway management in routine cleft lip surgeries. It possesses advantage over flexometallic tube and PVC tube. As it is a preformed tube passing suction catheter is technically difficult.