Anesthesia for tracheal reconstruction supported by tracheal T-tube--a modification of the Montgomery's method

Even though high frequency ventilation is the most important anesthetic ventilation technique for patients who have tracheal T-tube, other method is still in use, especially the Montgomery's method. In our daily practice, we found that there are some practical problems in the application of the Montgomery's method. Firstly, air leakage is present due to the presence of the Fogarty catheter at the connection of T-tube and endotracheal tube. Secondly, the internal diameter of the extraluminal limb of T-tube is smaller than the internal diameter of the intraluminal limbs, and the internal diameter of the endotracheal tube is smaller than the internal diameter of the extraluminal limb. This causes an increase in airway pressure in some patients. Thirdly, the endotracheal tube may kink and reduce the effective size of the lumen. Fourthly, the operation field may be interfered by the tube. We have designed a modification to solve these problems. A non-kinking endotracheal tube was used and the distal end of the non-kinking endotracheal tube was pushed to fit into the extraluminal limb of a T-tube. The other proximal end was connected to a mask elbow which was equipped with a sampling port. A Fogarty catheter was passed through the sampling port of the mask elbow and the trio attachment (mask elbow, non-kinking endotracheal tube, and T-tube) into the upper intraluminal limb of the T-tube. The balloon of the Fogarty catheter was inflated to occlude the opening of the upper intraluminal limb. Ventilation was performed by connecting the free end of the mask elbow to the anesthesia ventilator.(ABSTRACT TRUNCATED AT 250 WORDS)