Proper fixation of endotracheal tube (ETT) in cleft lip and palate surgery is considered a matter of utmost importance for the anesthesiologist. Various methods have been described previously for securing ETT, like using pre-formed tubes (Ring Adaire and Elvin tube, oxford tube) fixed with adhesive tapes to the middle of the chin, using surgical suture1 or k-wire to fix the tube to the teeth2 or using PVC sheet as a fixation device.3 These surgeries need special attention and strict vigilance during scrubbing, cleaning, and blood spillage intraoperatively. The adhesive plaster used for fixation usually gets wet and easily loses its adhesiveness. Subsequently, dislodgement of ETT may occur. Application of surgical suture or k-wire for tube fixation can be traumatic to patient, thus increasing post-operative morbidity. PVC sheet used as a device for tube fixation can be helpful in cleft lip surgery but its application is time consuming and more complex as compared with other fixation devices.
We hereby, have used Tegaderm™ (3M) transparent dressing for fixation of ETT in children of all age groups scheduled for cleft lip and palate surgeries (Fig. 1). Tegaderm™ consists of a transparent, thin polyurethane membrane coated with a layer of an acrylic adhesive. It is frequently used in treatment of minor burns and injuries (abrasions, lacerations), pressure areas, donor sites, post-operative wounds and for retaining peripheral and central IV catheters.
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It is a sterile, waterproof, clear, thin film daubed with an adhesive that is specially formulated to provide greater holding power on moist skin conditions. It easily conforms to body and flexes with skin. It is transparent and enables better monitoring of ETT site. It has a unique frame for easy application. The manufacturer guarantees that this dressing is waterproof, yet permeable to water vapor and oxygen. It is characteristically impermeable to micro-organisms and consequently, reduces the chances of skin lesions (ulceration, blisters) and external contamination. We exploited these unique properties of ‘Tegaderm’ dressing for securing ETT in cleft lip and palate surgeries in more than 1000 cases in 4 years in a tertiary care superspeciality hospital. Moreover, exit being transparent the ETT site as well as the area around can be easily visualized by surgeon, thus reducing the possibility of damage to ETT. Our experience in this regard has encouraged us to use Tegaderm in other head and neck surgeries successfully.
We have also used Tegaderm for tube fixation in ICU patients requiring prolonged ventilatory support. Oral hygiene, patients’ comfort, nurse’s satisfaction, ease of use, and fewer incidences of local infection and skin lesions were observed using Tegaderm more than 4 years in our 30-bed ICU. Yet other innovative and novel uses can be evaluated in future.