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Correspondence  |   May 2003
Use of the Cook Airway Exchange Catheter® to Facilitate Fiberoptic Intubation: Are We Trying to Solve a Problem That We Created?: In Reply:—
Author Notes
  • American University of Beirut, Beirut, Lebanon.
Article Information
Correspondence
Correspondence   |   May 2003
Use of the Cook Airway Exchange Catheter® to Facilitate Fiberoptic Intubation: Are We Trying to Solve a Problem That We Created?: In Reply:—
Anesthesiology 5 2003, Vol.98, 1293. doi:
Anesthesiology 5 2003, Vol.98, 1293. doi:
In Reply:—
Thank you for referring to me the letter of Drs. El-Orbany, Klimas-Osolkowski, and Salem. We agree with Dr. El-Orbany et al.  that the difference between the OD of the fiberoptic bronchoscope (FOB)(3.8 mm) and the ID of the endotracheal tube (ETT) (7.5–8 mm) contributed to the high incidence of failure in advancing the ETT over the FOB. However, in our department and in many other institutions, the 3.8 mm FOB may be the only available size. In order to solve this problem, multiple maneuvers have been suggested to facilitate the advancement of the ETT, such as 90-degree anticlockwise rotation and designing different tube tips. 1 Moreover, we have designed a removable conical polyvinyl chloride sleeve to sheath the insertion cord of the FOB, which increases its size from 3.8 mm to 5.5 mm; the use of this sleeve technique increases the incidence of successful advancement from the first attempt to 96%. 2 
Our report shows that failure from the first attempt when using the FOB alone amounts to 32%. It is only in these failed attempts that we introduced the Cook Airway Exchange Catheter® (Cook Critical Care, Bloomington, IN), which increased the success rate up to 9 of 16 from the first attempt. Also, as mentioned in our manuscript, when the ETT tube failed to pass over the FOB to the trachea, the FOB was not withdrawn, and the tip of the ETT tube was kept in close proximity to the glottis, which facilitated the introduction of the Cook Airway Exchange Catheter® from the first attempt.
In conclusion, we agree with Dr. El-Orbany et al.  that the use of a proper technique is the best prophylaxis against the failure of ETT advancement over the FOB. However, we can still encounter failure to advance the tube over the FOB despite the use of a larger FOB or a smaller tube size, the application the jaw thrust maneuver, generous lubrication, and 90-degree counterclockwise rotation. It is this situation that the introduction of Cook Airway Exchange Catheter® can centralize the tube in front of the glottis and facilitate advancement.
References
Baraka A, Rizk M, Muallem M, Bizri SH, Ayoub C: Posterior-beveled versus lateral-beveled tracheal tube for fiberoptic intubation. Can J Anesthesia 2002; 49: 889–90Baraka, A Rizk, M Muallem, M Bizri, SH Ayoub, C
Ayoub CM, Rizk M, Yaacoub Ch, Baraka A, Lteif A: Advancing the tracheal tube over a flexible fiberoptic bronchoscope by a sleeve mounted on the insertion cord. Anesth Analg 2003; 96: 290–2Ayoub, CM Rizk, M Yaacoub, Ch Baraka, A Lteif, A