Tonsillectomy – anaesthetic technique and the new disposable surgical equipment

The new disposable surgical equipment for tonsillectomy has raised issues about the changes which may be necessary in anaesthetic technique to comply with the new regulations [1, 2]. For economic reasons, there may be a resurgence in the popularity of the tracheal tube as an airway maintenance device as it is cheaper than the laryngeal mask. We have encountered a potential problem with the new surgical equipment when used in conjunction with a small tracheal tube. A 3-year-old child was anaesthetised for tonsillectomy and adenoidectomy and a size 4.5 tracheal tube was inserted. During the operation, the tracheal tube prolapsed between the gap in the tongue retractor, which resulted in obstruction of the tube. Repositioning of the retractor resulted in easy ventilation but when the tongue retractor was removed it was found that the tracheal tube was inextricably wedged in the gap (Fig. 3). It was fortunate that the planned anaesthetic technique in this case included a deep extubation. In a previous case with an older child, a size 5.0 tube pushed through the gap and made it difficult to perform the operation until a piece of tape was used to cover the gap between the two sides of the retractor. Since many tonsillectomies are performed on children who need tracheal tubes that are small enough to herniate through the gap, this problem is likely to recur.