New approach to anaesthetizing a patient at risk of pulmonary aspiration with a Montgomery T-tube in situ

We describe our airway management in a patient requiring emergency laparotomy with a Montgomery T-tube in situ. This uncuffed silicone T-tube acts as both stent and tracheostomy after laryngotracheal surgery, and entails various difficulties for the anaesthetist. Several anaesthetic techniques have been described for T-tube insertion. The management of patients with a T-tube in situ, at risk of pulmonary aspiration, has not been addressed. Below, we present some possible approaches to this problem and describe how we successfully carried out an awake fibreoptic intubation via the tracheal limb of the T-tube. This technique might be considered for patients in similar circumstances, but knowledge of relevant internal and external tube diameters, and appropriate tracheal tube size selection, is crucial.