Guide Wire J-Tip Technique for Easy Exchange of In Situ Endotracheal Tubes

Dear Editor, Endotracheal intubation (ETI) is a simple, rapid, safe and non-surgical technique for airway management. It maintains airway patency, protects the lungs from aspiration, and permits leak-free ventilation during mechanical ventilation. The anesthesiologists’ knowledge, technical skills and crisis management capabilities play an important role in controlling the occurrence of unwanted complications during airway management.1 In anesthesiology, leaking cuff is one of the problems occurring after correct endotracheal intubation. It usually occurs when the cuff is damaged by contact with teeth, nasal bone or Magill forceps during mechanical ventilation in which the tracheal tube should be removed and replaced. In patients with impossible manipulation of the neck, injuries to the cervical vertebrae of their neck, or difficult intubation, it is necessary to use a fiberoptic bronchoscope for reintubation most of the times. Direct laryngoscope with Macintosh blade for intubation is the first selection in cases of difficult intubation.2 Using laryngoscope produces reflex sympathetic stimulation, and subsequently increases heart rate, blood pressure, intracranial pressure, myocardial ischemia, and cardiac arrhythmia. Complications of airway problems often result in morbidity and mortality in anesthesia.1 Inadequate cuff seal is common and leads to hypoventilation during mechanical ventilation and aspiration of gastric contents. The most common cause of reintubation during anesthesia in the operating room is upper airway obstruction and hypoventilation. Endotracheal tube cuff laceration during anesthesia is often associated with respiratory complications, reduction of arterial haemoglobin oxygen saturation, and inappropriate ventilation of the lungs. Therefore, the exchange of endotracheal tube and proper replacement with an adequate tube plays an important role. Care must be taken to reduce neck manipulation, minimize use of laryngoscopy, and cause less sympathetic stimulation. Guide wire “j” tip catheter, which is a central venous catheter, is suggested for the exchange of a tracheal tube during anesthesia without using fiberoptic bronchoscope or laryngoscopy (figure 1).