Prevention of bronchial intubation with RAE tube during adenotonsillectomy

Oral RAE performed tracheal tubes [I] are frequently used during anaesthesia for adenotonsillectomy in children as they allow better access for the surgeons. However, placement of the Boyle-Davis gag, and keeping the oral tube clear of the operative field, poses two problems. Firstly, compression or kinking of the tube [2,3] may lead to upper airway obstruction due to the pressure of the gag on the tube. The second problem is inadvertent bronchial intubation [4], which is a common complication with the RAE tubes. Bronchial intubation may not occur immediately after intubation. On inserting the mouth gag, the tip of the tube may be advanced into a bronchus if it already lies close to the carina. My own practice of using the RAE tube in these circumstances is to press the tube against the tongue with a finger immediately after intubation. This manoeuvre simulates the action of the Bolyle-Davis gag and reliably predicts bronchial intubation that may occur after insertion of the gag. Intra-operative accidental bron-chial intubation related to the use of the RAE tube and the Boyle-Davis gag can thus be prevented.