Parker Flex-Tip Tube vs Standard Tube for Fiberoptic Orotracheal Intubation

The Parker Flex-Tip Tube versus a Standard Tube for Fiberoptic Orotracheal Intubation: A Randomized Double-blind Study

Background:
During fiberoptic tracheal intubation, passage of the fiberscope itself to the trachea is often fairly easy, but passage of the tube into the trachea may be difficult or even impossible. A new type of disposable endotracheal tube, the Parker Flex-Tip tube, has a tip that reduces the gap between the fiberscope and the inside of the tube. Thus, theoretically, a smaller risk of impinging on laryngeal structures during insertion in trachea is expected.

Methods:
Eighty patients scheduled for elective anesthesia using orotracheal intubation were randomized to either a Parker Flex-Tip tube or a standard (Portex) 7.5-mm-ID endotracheal tube. Blinding was obtained by having the tube premounted on the fiberscope (Olympus LF-1; diameter of fiberscope = 4 mm) and thereafter covered with a black opaque plastic bag. Difficulty in placing the tube was scored using an objective standardized grading system.

Results:
Seventy-six patients completed the study. The use of the Parker Flex-Tip tube reduced the incidence of need for repositioning of the tube during insertion into trachea from 89% to 29% (P < 0.0001) when compared to the standard tube. The median time for passage of the tube into the trachea was reduced from 20 s to 7.5 s (P < 0.0001).

Conclusions:
During oral fiberoptic intubation, the use of the Parker Flex-Tip tube is associated with greater incidence of initial success of passage of the tube into trachea when compared to a standard endotracheal tube.

*Assistant Clinical Professor.

Received from the Department of Anaesthesia, Center of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Submitted for publication June 12, 2002. Accepted for publication October 8, 2002.

The Department of Anesthesia, Center of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, supplied the manpower necessary to perform the study during routine clinical work and supplied the standard endotracheal tubes. The investigated endotracheal tubes were supplied by Maersk Medical, Lynge, Denmark.

Address reprint requests to Dr. Kristensen: Department of Anaesthesia, 4132, Center of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Address electronic mail to: msk@rh.dk. Individual article reprints may be purchased through the Journal Web site, www.anesthesiology.org.