Comparison of two techniques of insertion of oesophageal-tracheal double lumen airway (Combitube®)

The use of Combitube® can be considered in patients with previously unrecognised difficult airway. It secures the airway and protects it against aspiration of regurgitated gastric contents but its insertion is associated with a high incidence of complications. We compared two techniques of insertion of the Combitube® in 37 patients undergoing gynaecological laparoscopic surgery. They were divided into two groups: The Combitube® was inserted blindly in Group B (n=19) and was laryngoscope-aided in Group L (n=18). The time to successful insertion was significantly shorter in Group B (44s) Vs Group L (56s) but the ease of insertion was graded significantly better using a laryngoscope. The incidence of sore throat/hoarseness was significantly higher in Group B (78.9%) as compared to Group L (38.8%). The incidence of trauma as evidenced by blood on the tube was 68% and 50% in Group B and Group L respectively. The anaesthetic can be safely continued with a Combitube® in place. However, the design of the tube precludes direct access to the trachea.