Awake tracheal placement of the Tritube® under flexible bronchoscopic guidance

Awake tracheal placement of the Tritube® under flexible bronchoscopic guidance

Published: 02 Jul 2018

© Anaesthesia Cases / 2018-0097 / ISSN 2396-8397


Dr Kayathrie Jeyarajah [1]
Dr Imran Ahmad [2]
  • [1] Senior Registrar, Anaesthetics, Guy's & St Thomas' NHS foundation Trust, london, United Kingdom
  • [2] Consultant, Anaesthetics, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom


A 71-year-old male with hoarse voice was referred to our institution for panendoscopy. Previous radiotherapy for piriform fossa carcinoma resulted in a ‘radiotherapy neck' and reduced neck extension.  He also had a background of severe chronic obstructive pulmonary disease (COPD). In view of his anticipated difficult airway combined with airway pathology and COPD, we opted for awake tracheal placement of a novel tracheal tube, the Tritube®, and ventilation using the Evone® ventilator (Ventinova Medical B.V., Eindhoven, Netherlands). After successful awake placement of the flexible bronchoscope, the Tritube® was passed alongside, guided by a silk suture which was inserted through the lumen of the tube and then tied over the bronchoscope.  Once correct placement was confirmed, the patient was successfully ventilated throughout the procedure with the Evone® ventilator. The narrow lumen of the Tritube® allowed adequate surgical access with the advantage of a definitive airway, whilst continuous ventilation was delivered. To our knowledge, this is the first reported case of an awake tracheal placement of the Tritube® with ventilation via the Evone® ventilator.

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