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Correspondence  |   July 1997
Oversize Endotracheal Tubes and Intubation via Laryngeal Mask Airway 
Author Notes
  • Department of Anesthesiology and General Intensive Care, University of Vienna, Wahringer Gurtel 18–20, Vienna, A-1090, Austria (C. A. Preis).
  • Department of Anesthesiology, University of Wurzburg, Germany (I. S. Preis).
Article Information
Correspondence
Correspondence   |   July 1997
Oversize Endotracheal Tubes and Intubation via Laryngeal Mask Airway 
Anesthesiology 7 1997, Vol.87, 187. doi:
Anesthesiology 7 1997, Vol.87, 187. doi:
To the Editor:-A standard endotracheal tube (EET) often is found to be too short to be used safely in cases of fiberoptic intubation through an laryngeal mask airway (LMA). As a simple and practical alternative to using a standard ETT, Alfery suggested the use of a 6.0-mm internal diameter (ID) nasal RAE tube (developed by the medical professionals Ring, Adair, and Elwyn, made by Mallinckrodt (St. Louis, MO), with a length of 34 cm. [1 ] If this specialty ETT is in stock in anesthesia storerooms and is readily available for patients with difficult airway, it may facilitate mid-tracheal intubation via LMA. If such a 6.0-mm ID nasal RAE tube or another oversize 6.0-mm ID endotracheal tube is not already in stock, we would urge considering stocking anesthesia storerooms with a specialty ETT to facilitate fiberoptic intubation via LMA.
Suitable are, for example, a 6.0-mm ID microlaryngeal tube (34-cm long), a 6.0-mm ID nasal RAE tube (length, 35-cm), both produced by Mallinckrodt, or another oversized 6.0-mm ID microlaryngeal tube (MLT), with a length of 40 cm (Rusch Incorporated, Duluth, GA). These tubes are narrow enough to pass through the size 3 or 4 LMA shaft and long enough to allow mid-tracheal positioning of the ETT's tip.
For several years, we have used the 40-cm long 6.0-mm ID MLT when intubation is to be performed via LMA. With respect to our data, we can recommend the use of this MLT, 40 cm in length, in patients with difficult airway. [2 ] To date, in about 15 patients with unexpected difficult airway, we were able to perform safe and gentle placement of this globally available MLT via LMA, and, additionally, because of its extraordinary length, the LMA could be removed without dislodging the MLT.
Carsten A. Preis, M.D.
Department of Anesthesiology and General Intensive Care; University of Vienna; Wahringer Gurtel 18–20; Vienna, A-1090; Austria
Irene S. Preis, M.D.
Department of Anesthesiology; University of Wurzburg, Germany
(Accepted for publication April 26, 1997.)
References 
References 
Alfery DD: Laryngeal mask airway and the difficult airway algorithm I (Letter to the Editor). Anesthesiology 1996; 85:685.
Preis IS, Preis CA: Die fiberoptische Intubation mit einem uberlangen Tubus via Larynxmaske bei unerwartet schwieriger Intubation (Abstract). Anaesthesist 1995; 44:(Supp 2)S461.