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Related Concept Videos

Cardiopulmonary Resuscitation II: ACLS Airway Management01:22

Cardiopulmonary Resuscitation II: ACLS Airway Management

Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned under...
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Updated: Jun 18, 2026

The Rigid Tube as an Alternative in Controlling the Problematic Airway
08:26

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Published on: June 6, 2020

Managing Oral RAE Tube Malpositioning After Neck Extension.

Masanori Tsukamoto, Michi Eto, Yusuke Oku

    Anesthesia Progress
    |June 17, 2026
    PubMed
    Summary

    Oral Ring-Adair-Elwyn (RAE) endotracheal tubes (ETTs) risk malpositioning during cleft lip/palate surgery. A study found 8% malpositioning after neck extension, suggesting wire-reinforced ETTs as a safer alternative.

    Keywords:
    General anesthesiaOral intubationRAE tubeWire-reinforced tracheal tube

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    Published on: August 2, 2024

    Area of Science:

    • Anesthesiology
    • Pediatric Surgery
    • Orofacial Cleft Surgery

    Background:

    • Cleft lip and palate require surgical repair, often involving endotracheal intubation for airway management.
    • Oral Ring-Adair-Elwyn (RAE) endotracheal tubes (ETTs) are commonly used due to their preformed curve, facilitating intubation in these cases.
    • However, the fixed curve of RAE ETTs can limit depth adjustment and predispose to malpositioning, particularly with head and neck movements.

    Purpose of the Study:

    • To assess the incidence of inadvertent malpositioning of oral RAE ETTs during airway management in patients undergoing cleft lip and palate repair.
    • To evaluate the suitability of wire-reinforced endotracheal tubes as a secondary option for managing airway in these complex surgical cases.

    Main Methods:

    • A prospective study involving 186 patients undergoing cleft lip and palate surgery, initially intubated with oral RAE ETTs.
    • Assessment of ETT positioning after head and neck extension maneuvers during general anesthesia.
    • Comparison of outcomes and consideration of alternative airway management strategies.

    Main Results:

    • An 8% incidence rate of inadvertent ETT malpositioning was observed after head and neck extension in patients initially intubated with oral RAE ETTs.
    • Malpositioned RAE ETTs were identified as potentially causing vocal cord compression due to cuff displacement.
    • Wire-reinforced ETTs were found to be a suitable alternative, tolerating extreme flexion without kinking or collapse.

    Conclusions:

    • Oral RAE ETTs, while useful in cleft lip and palate surgery, carry a significant risk of malpositioning following neck extension.
    • Close monitoring and assessment of ETT position are crucial after head and neck manipulation.
    • Wire-reinforced ETTs are recommended as a reliable secondary option to mitigate risks associated with RAE ETT malpositioning.