To the Editor

I have read with interest the recent protocol suggested

by Drs. Kataria and Nicodemus for ventilatory difficulty subsequent to intubation. In the Fall 1990 issue of the Newsletter. It calls for passing a suction catheter through the endotracheal tube following direct laryngoscopy.

This procedure may not detect a significant problem in the endotracheal tube and why waste valuable time I and others haw noted on occasion the ease with which a suction catheter may be passed through a large, tenacious mucus plug in an endotracheal tube. The ability to pass a catheter with apparent ease does not insure a patent endotracheal tube.

Perhaps the protocol would more appropriately state:

3. Release endotracheal tube cuff and manipulate endotracheal tube: rule out herniation of cuff, kinked, compressed, bevel of endotracheal tube against tracheal wall. If difficulty continues, change endotracheal tube.

One must not allow the possibility of profound anesthetic morbidity or mortality to result from a catheter patent but functionally blocked endotracheal tube.

Jonathan D. Lamb, M.D., FRCP(C)

Clinical Assistant

Professor of Anesthesia

Saskatoon, Saskatchewan, Canada