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Correspondence  |   November 2003
Is the Parker Flex-Tip Tube Really Superior to the Standard Tube for Fiberoptic Orotracheal Intubation?
Author Affiliations & Notes
  • Anthony M-H. Ho, M.Sc., M.D., F.R.C.P.C., F.C.C.P.
    *
  • *The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Peoples’ Republic of China.
Article Information
Correspondence
Correspondence   |   November 2003
Is the Parker Flex-Tip Tube Really Superior to the Standard Tube for Fiberoptic Orotracheal Intubation?
Anesthesiology 11 2003, Vol.99, 1236. doi:
Anesthesiology 11 2003, Vol.99, 1236. doi:
To the Editor:—
Dr. Kristensen 1 has concluded that during intubation with the use of a flexible fiberscope, the use of the Parker Flex-Tube results in a significantly lower rate of repositioning and repeated attempts at passing the tube into the trachea, compared to a standard endotracheal tube. We believe it would be more appropriate to conclude that the Parker tube is better only when the standard tube is improperly oriented during passage. Dr. Kristensen reported that once the standard tube was rotated counterclockwise by 90 degrees, its success rate improved to 26 out of 38 attempts. 1 This was essentially the same as the success rate (27 out of 38 attempts) of the Parker tube 1 and is consistent with our experience with the standard tube. Why not simply start with the standard tube rotated counterclockwise by 90 degrees? The Parker tube requires a higher cuff pressure, 1 which, in our opinion, makes it less desirable.
The simple technique of rotating the standard tube counterclockwise by 90 degrees during the first  attempt along a fiberoptic bronchoscope has been our standard practice for years, thanks to a suggestion by Katsnelson et al.  in 1992. 2 Eighteen years ago, Cossham 3 proposed rotating a standard tube counterclockwise by 90 degrees to facilitate passage along a gum-elastic bougie, and in 1990, Dogra et al.  demonstrated convincingly the usefulness of this technique. 4 Granted, this technique may not be widely appreciated, perhaps because the gum-elastic bougie is not used in some parts of the world and the use of fiberoptic bronchoscopy is infrequent. 1 As such, Dr. Kristensens'study 1 should help to popularize this important “trick.”
References
Kristensen MS: The Parker Flex-Tip tube versus  a standard tube for fiberoptic orotracheal intubation: A randomized double-blind study. A nesthesiology 2003; 98: 354–8Kristensen, MS
Katsnelson T, Frost EAM, Farcon E, Goldiner PL: When the endotracheal tube will not pass over the flexible fiberoptic bronchoscope (letter). A nesthesiology 1992; 76: 151–2Katsnelson, T Frost, EAM Farcon, E Goldiner, PL
Cossham PS: Difficult intubation (letter). Br J Anaesth 1985; 57: 239Cossham, PS
Dogra S, Falconer R, Latto IP: Successful difficult intubation: Tracheal tube placement over a gum-elastic bougie. Anaesthesia 1990; 45: 774–6Dogra, S Falconer, R Latto, IP