A ‘Y’-shaped connector as an indispensable component of paediatric bronchoscopy mask: A novel innovation!

A 'Y'‑shaped connector as an indispensable component of paediatric bronchoscopy mask: A novel innovation! Sir, Fibre‑optic bronchoscopy (FOB) has widespread diagnostic and therapeutic role in the form of its use in difficult intubation, bronchoalveolar lavage or biopsies. FOB‑guided intubation in paediatric patients with difficult airway could be a challenge and the presence of craniofacial dysmorphisms presents additional challenges. Although awake FOB‑guided intubation is recommended for intubation of patients with difficult airways, same may not be feasible in paediatric patients primarily because of cooperation issues. Some practitioners prefer performing fibre‑optic intubation on anaesthetised and paralysed patients. Smaller airways, easy airway collapsibility at end expiration and reduced functional residual capacity make them susceptible to frequent desaturation during FOB, thus requiring frequent interruptions resulting in delay and at times abandonment of procedure. The pre‑procedural anaesthesia care in such scenarios can be rendered safe by the use of bronchoscopy masks which are designed to allow bag and mask ventilation (BMV) during FOB or allow prolonged attempts at FOB‑guided intubation. A number of such masks are available, which have more or less a common design namely a standard mask with a 22 mm central port and 1–2 ports of varying dimensions for introducing FOB. Some have provision for intubation and EtCO 2 monitoring. However, their price is a principal deterrent to their widespread use. We describe an assembly, made with components commonly available in our operating rooms which can be assembled to serve the role of bronchoscopy mask. The components of this device [Figure 1a and b] include a transparent face mask, a 'Y'‑shaped reusable connector used in paediatric anaesthesia circuits, a connector of 6.5 internal diameter (ID) sized endotracheal tube (ETT), three cut fingers portion and elastic ring from a disposable sterile glove. 'Y'‑shaped connector is integral to this assembly. It has two limbs each having an ID of 6.5 mm and a 22 M main stem. Connector of 6.5 ID sized ETT is connected to one of the limbs of the connector and is used for attachment to the anaesthesia circuit. The cut fingers portion of the glove is stretched over the other limb of the connector and is secured using the elastic ring of the glove. Although 22 M main stem fits firmly in the standard 22F sized aperture of the face mask, it can be easily rotated to change the position of the two limbs depending on the choice of orotracheal …