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Draping for neck surgery requiring endotracheal tube manipulation

Published online by Cambridge University Press:  18 October 2011

C L Dalton ,
P J Clamp  and
G C Porter
C L Dalton*
Affiliation:
Department of Ear, Nose and Throat Surgery, Leighton Hospital, Crewe, UK
P J Clamp
Affiliation:
Department of Ear, Nose and Throat Surgery, Gloucestershire Royal Hospital, Gloucester, UK
G C Porter
Affiliation:
Department of Ear, Nose and Throat Surgery, St Michael's Hospital, Bristol, UK
*
Address for correspondence: Mrs C L Dalton, Department of Ear, Nose and Throat Surgery, Leighton Hospital, Crewe CW1 4QJ, UK E-mail: clucydalton@doctors.org.uk
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Abstract

During airway surgery, the anaesthetist may be required to manipulate or withdraw the endotracheal tube. Traditional surgical head drapes often make access to the tube difficult, therefore limiting control of the airway and risking de-sterilisation of the surgical field. We report a new method of draping for major neck operations that permits easy access to the endotracheal tube while maintaining sterility of the operative field.

Keywords

Otorhinolaryngologic Surgical ProceduresTracheostomyLaryngectomyIntubationIntratrachealBedding and Linens
Type
Short Communication
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 3 , March 2012 , pp. 307 - 308
Copyright
Copyright © JLO (1984) Limited 2011

Introduction

Surgical draping for head and neck procedures can be difficult because of the need for both anaesthetic and surgical access.Reference Landsman and Allora1–Reference Tuerk6 Major neck operations often involve head drapes. In cases such as tracheostomy or laryngectomy, the anaesthetist is required to withdraw the endotracheal tube during surgery. When the head drape covers the mouth, access to the endotracheal tube is difficult. This limits control of the endotracheal tube during manipulation and risks the sterility of the operative field.

We report a new technique of draping for major neck operations that permits easy access to the endotracheal tube and maintains operative sterility at all times.

Technique

Following routine skin preparation, the patient's head is enclosed in a head drape that excludes the endotracheal tube. This is facilitated by briefly disconnecting the endotracheal tube from the anaesthetic circuit while the head drape is being applied. The head drape controls the patient's hair and preserves the sterility of the postero-superior surgical field (Figure 1).

Fig. 1 The first head drape is placed cranial to the mouth and excludes the endotracheal tube.

A second adhesive drape is then placed at the level of the mandible in order to cover the endotracheal tube and the mouth (Figure 2). This drape preserves the sterility of the antero-superior surgical field.

Fig. 2 The second, adhesive head drape is placed across the chin to cover both the mouth and the endotracheal tube.

When the endotracheal tube needs to be manipulated or withdrawn intra-operatively, the second drape can be lifted with ease (Figure 3). This permits easy access to the endotracheal tube and mouth while preserving an aseptic operative field.

Fig. 3 The second head drape can be lifted intra-operatively to access the endotracheal tube. The airway can be adjusted and withdrawn at any stage, while maintaining sterility of the operative field.

Conclusion

Surgical draping for major neck operations can limit the anaesthetist's access to the airway and compromise sterility of the surgical field during endotracheal tube manipulation. The draping technique we report avoids these problems by separating the anaesthetic and surgical fields while providing ample space for both. We have been using this technique for a number of years and have found it to be highly effective.

References

1Landsman, JS, Allora, LP. Surgical draping of the nasoendotracheal tube. J Oral Surg 1975;33:629Google ScholarPubMed
2Masud, D, Gilbert, P. Secure sterile head drape for head and neck surgery. J Plast Reconstr Aesthet Surg 2009;62:143–4CrossRefGoogle ScholarPubMed
3Pender, JW. Surgical drape support for operations on the neck or upper part of the thorax. Proc Staff Meet Mayo Clin 1955;30:44Google ScholarPubMed
4Richardson, HD, Chakravorty, RC. Adjunct to draping of head and neck. AORN J 1984;40:940CrossRefGoogle ScholarPubMed
5Terz, JJ, Brown, PW, Lawrence, W Jr. The draping of the surgical field for major head and neck surgery. Am J Surg 1977;134:304–6CrossRefGoogle ScholarPubMed
6Tuerk, M. A technique for draping of the infant for surgery of the head and neck. Plast Reconstr Surg 1985;75:590–1CrossRefGoogle ScholarPubMed
Figure 0

Fig. 1 The first head drape is placed cranial to the mouth and excludes the endotracheal tube.

Figure 1

Fig. 2 The second, adhesive head drape is placed across the chin to cover both the mouth and the endotracheal tube.

Figure 2

Fig. 3 The second head drape can be lifted intra-operatively to access the endotracheal tube. The airway can be adjusted and withdrawn at any stage, while maintaining sterility of the operative field.