Orotracheal tube fixation in children undergoing cleft lip and palate surgery

摘要

To the Editor:We read, with great interest, the recent letter written by Drs. Agarwal et al. regarding a new technique for midline orotracheal tube fixation. We agree withtheir view that fixation of the endotracheal tube (ETT) in the midline is desirable for better preservation of anatomical landmarks in children receiving cleft lip and palate surgery. However, the reasoning is unclear, from their description, as to why the chances of life threatening complications, including accidental extubation, endobronchial intubation, and kinking, are increased whenever the ETT is fixed in the midline. In fact, fixing the ETT at the angle of the mouth (i.e., placing it at the narrow position between the maxillary and mandibular teeth) may result in a higher risk of ETT obstruction compared to ETT fixation in the midline, particularly when anesthesia is administered without muscle relaxants, or when the ETT migrates laterally between the upper and lower molars.2