Less tongue engorgement with lateral placement of the Esophageal Tracheal Combitube

The conventional technique of insertion and fixation of the Esophageal Tracheal Combitube (ETC) is occasionally associated with engorgement of the tongue. This study sought to evaluate the efficacy of an alternative placement technique in reducing the incidence of this complication.

Thirty ASA I and II adult patients posted for elective surgery under general anaesthesia lasting from 30 to 120 min were randomly divided into two groups (n=15, each). In Group A, the ETC was inserted and fixed in the midline. In Group B, the ETC was inserted along the angle of the mouth and was fixed at this lateral position. Intra-operative occurrence of engorgement of the tongue, the time of such an occurrence and any complaints of post-operative discomfort were recorded.

The overall incidence of engorgement of the tongue in Group A patients (67%) was significantly more (P<0.01) as compared with Group B (17%). The incidence significantly increased (P<0.01) with an increase in the duration of surgery in both the groups. The engorgement persisted into the post-operative period in three patients in Group A and resolved spontaneously in <15 min in each case.

Lateral insertion and fixation of the ETC is an easy, safe and effective method of preventing engorgement of the tongue associated with the use of this device without compromising a leak-proof oropharyngeal cavity.