Editor—Editor,—Masterset al describe how a modified endotracheal tube can be used as a nasopharyngeal airway in infants with Pierre Robin syndrome.1 We describe further modifications made to overcome some problems which we encountered in using the technique in one of our patients.

In the original description the protruding part of the airway is cut into four strands and the upper one cut off. We found the remaining strands rather thick, so cut them to half the width. We found that leucoplast tape was the only tape that held the strands in place with no additional benefit resulting from the use of Tinc Benz. The strands rubbed badly where they curved over the edge of the nostril. To overcome this a piece of suction catheter (8F) of just sufficient length to extend over the lateral and medial walls of the nostril is tied transversely across the tube with a 3/O silk tie (fig 1). This lifts the three strands off the edge of the nostril and prevents any rubbing.

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Figure 1

The modified nasopharyngeal airway in place.

In our patient blockage of the airway occurred after formula but not breast milk feeds. It is therefore advisable to suction the airway after each feed. We used a suction catheter with graduation marks enabling insertion no further than the tip of the airway. If inserted further the pharyngeal stimulation usually caused vomiting.

If a nasogastric tube is also required this can be taped to one of the strands rather than the face. The airway was changed every four to six days, immediately before a feed and alternating between nostrils. Using 1% lignocaine drops and smearing the tube with lignocaine jelly reduced crying time after insertion.

Compared to the use of an unmodified tube with a large connector attached to the end, we feel that the technique described by Masterset al is far superior as it enables the child to lie prone and is less liable to get knocked or blocked through kinking. We suggest that the modifications we have described will further improve the acceptability of the technique.