Combitube
The Combitube (Sheridan Catheter, Argyle, NY) is another supraglottic
airway device that can provide an emergency airway when conventional means are not
effective or possible. The Combitube has two lumens so that it can function appropriately
whether placed in the trachea or, much more commonly, in the esophagus ( Fig.
42-13
). It also possesses an esophageal balloon to provide for protection
from aspiration, which may represent an advantage over the LMA in obstetric anesthesia.
The Combitube has been used successfully in cardiopulmonary resuscitation and probably
presents a lower risk of esophageal rupture than the older esophageal obturator airway.
Care must also
Figure 42-13
Insertion of the Combitube. A,
The tongue and mandible are lifted with one hand, and the Combitube is inserted in
the direction of the natural curvature of the pharynx with the other hand. The printed
ring is aligned with the teeth. B, The pharyngeal
cuff is inflated with 100 mL of air, and the distal cuff is inflated with 15 mL.
C, Ventilation is begun through the longer no. 1
tube because placement is usually in the esophagus. D,
If ventilation is absent and the stomach is being insufflated, begin ventilation
through the no. 2 connecting tube. (Courtesy of Sheridan Catheter Corp.,
Argyle, NY.)
be taken to avoid excessively deep placement in the esophagus, which obstructs the
glottic openings.[15]
The Combitube is contraindicated
for patients less than 5 feet tall and those with intact gag, esophageal disease,
or caustic ingestion. A redesigned Combitube with a larger pharyngeal orifice has
been found effective in providing a conduit for tracheal suctioning, fiberoptic bronchoscopy,
and the use of a guidewire for tube exchange.[16]
The practicing clinician can probably anticipate continued modifications in the
present supraglottic devices and the introduction of new modalities to maintain and
protect the airway without tracheal intubation. Many of these are surrogates of
the LMA such as the laryngeal tube and the perilaryngeal airway (Cobra-PLA, Engineering
Medical Systems, Inc., Indianapolis, IN).
