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Pulmonary aspiration of gastric contents during general anaesthesia can be fatal. A 1956 report identified pulmonary aspiration as the commonest cause of death during general anaesthesia and NAP4 reported similarly in 2011. Major efforts have been made to reduce its incidence. Cricoid pressure (force) was introduced in the 1960s but remains controversial. Recent studies and new techniques have shed further light on the debate. The role of second generation supraglottic airway devices and videolaryngoscopy is also discussed.
This chapter concentrates on characteristics of the cuffed tube. With a cuffed tube, it is important that the insertion depth is sufficient to avoid inflating the cuff within the larynx itself. Cuffed tubes are generally used in adult practice to seal the airway to protect it from soiling from above and to prevent gas leaks. Three factors contribute to the extent of cuff induced tracheal damage: cuff characteristics, cuff pressure regulation, and cuff inflation technique and medium. Tracheal tubes are attached to the breathing system via tapered male to female 15 mm International Organization for Standardization (ISO) connectors. Tracheostomy tubes with a 15 mm ISO connector can be connected directly to a breathing circuit. Tube characteristics may influence the risk of ventilator-associated pneumonia (VAP). The chapter also reviews special tubes such as laser tubes, microlaryngoscopy tubes, and tubes for paediatric practice.