Comparison of tube-taping versus a tube-holding device for securing endotracheal tubes in adults undergoing surgery in prone position.

BACKGROUND: Endotracheal tube displacement is one of the leading causes for airway related complications. Endotracheal tube displacement is much more common in the prone position than in the supine position. METHOD: The study population consisted of 120 patients aged between 18-60 years, ASA class 1 and 2, undergoing surgery in the prone position who were randomly allocated into two groups of sixty patients each. The endotracheal tube was secured either with adhesive tape (Group A) or a Thomas tube holder (Group B). The ease of application and removal, effect on caliber of endotracheal tube, amount of displacement of endotracheal tube and also any injuries with either fixation method were studied. RESULT: Both groups were comparable with respect to mean time taken for the application of the fixation device, peak airway pressure change after the application of the fixation device in the supine position and after positioning the patient in the prone position and the time taken for removal of the fixation device. Displacement was significantly larger in group A than in group B. CONCLUSION: Both methods of fixation of the endotracheal tube are clinically useful in the prone position but the Thomas tube holder is more effective than adhesive tape in preventing displacement of endotracheal tube.

Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature.

We report a case of fatal pulmonary embolism (PE) following exsanguinations of lower limb in orthopedic surgery. A 30-year-old man was posted for fixation of a tibial plateau fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch bandage was used for exsanguination of the limb and tourniquet was inflated. Within three minutes after tourniquet inflation, the patient became unconscious hypotensive, and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right ventricular strain pattern on transthoracic echocardiography, increased levels of D-dimer, and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin, the patient died on the ninth day after the event. Cases of PE secondary to the use of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and management of PE.