Therefore, the exchange of endotracheal tube and proper replacement with an adequate tube plays an important role. Care must be taken to reduce neck manipulation, SB202190 mw minimize use of laryngoscopy, and cause less sympathetic stimulation. Guide wire “j” tip catheter, which is a central venous catheter, is suggested for the exchange of a tracheal tube during anesthesia without using fiberoptic bronchoscope or laryngoscopy (figure 1). Figure 1: Guide wire «j» tip used for changing the tracheal tube. To exchange a tracheal tube during anesthesia in operating room without using fiberoptic Inhibitors,research,lifescience,medical bronchoscope or laryngoscopy, a flexible guide wire “j” tip is inserted into the

Inhibitors,research,lifescience,medical previously perforated tube and the damaged tube is removed. Guide wire “j” tip remains in place, and a new tube is advanced over the guide wire “j” tip, and is correctly placed at the expected point. Then, guide wire “j” tip is removed slowly. After the evaluation of the lungs and ensuring adequate ventilation, the new tube is fixed with desired instruments. During the exchange and replacement of tracheal tube, hemodynamic parameters including, electrocardiogram monitoring, blood pressure, and hemoglobin oxygen saturation are protected and controlled continually (figure 2). Figure

2: Stages of change and replacement of the tracheal tube. Proper management of Inhibitors,research,lifescience,medical airway disorders and dealing Inhibitors,research,lifescience,medical with patients with difficult intubation is one of the problems, which an anesthesiologist experiences in the operation room. One of the common causes of endotracheal tube exchange for the patients in the operating rooms and intensive care units is tearing and laceration of endotracheal tube cuff. The use of different instruments to guide tracheal tube to make endotracheal tube exchange easy with no side Inhibitors,research,lifescience,medical effects in patients was described in 1981. Different techniques have suggested the use of varied instruments such as suction catheter, urethral catheter, fiberoptic bronchoscopy,3,4 stylet,5 endotracheal tube changer-guide,

gum-elastic bougie,6 cook airway exchange catheter,7 and endotracheal tube exchange.8 Advantages and disadvantages of each technique should be investigated. In guide wire “j” technique, the tip of the wire is used for exchanging endotracheal tube without using all fiberoptic bronchoscopy or causing harmful manipulation of neck. Advantages of this technique include availability of this instrument, simplicity of its use, and minimization the risk of serious hemodynamic complications. However, this technique may encounter two problems including the twisting of J-wire inside the endotracheal tube, and the obstruction of old tube by clot or mucous plaque, which should be cleared by suctioning before replacing the old tube with a new one.