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Anaesthesia by telephone: an aid to induction of anaesthesia in children

The nasal fossa, epipharynx and tracheal walls (through the glottis) were sampled for bacteriological examination before tracheal intubation. After the sheathed tube reached the epipharynx, just close to the glottis, a hood was cut out from the sheath end, corresponding to the tube tip, with long scissors. It was only then that, with Magill forceps, the tube was passed further into the trachea by sliding it within its sheath. Once anaesthesia finished, tracheal extubation under direct vision control, and after careful toilet of the pharynx, was performed. When the cuff and the end of the tube appeared in the pharynx, they were sampled for bacteriological examination. Sheaths, tubes, instruments and suction catheters were all sterile before use. The cultures were considered in relation to the bacteria which are normally found in the nasal fossa. These were compared with the cultures from the tracheal portion of the tube and the tip of the tube. The incidence of identical bacterial specimens is shown in Table I . The sheath offers significant protection. Nasotracheal intubation with such a tube-in-sheath is more difficult than usual. It might perhaps be reserved for those patients who require ventilatory assistance, but who are considered to have a low natural resistance. Manufacturers could find technical solutions to make it more practical. A removal mechanism for the hood, similar to that of the upper cellophane covering a cigarette packet, i.e. a tear-strip, might be considered.