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A simple technique for oesophageal stethoscopy.

Monitoring of the patient's ventilation and circulation remains of paramount importance during anaesthesia. Simple mechanical devices such as the oesophageal stethoscope remain useful (1) both when more sophisticated devices are available and in areas where expensive electronic monitors are not available. Paediatric anaesthesia is a discipline which has particularly utilised monitoring with a stethoscope, either oesophageal or external thoracic. Oesophageal stethoscopy provides reliable and continuous cardiopulmonary monitoring. The oesophageal stethoscope may also provide specialised information such as auditory signs of venous air embolism. The oesophageal stethoscope may also allow monitoring when a transthoracic stethoscope may not be practical due to the surgical site. Either monaural or binaural stethoscopes can be used, the former allowing better auditory connection with the rest of the operating theatre (1).

We suggest using a lubricated endotracheal tube passed into the oesophagus as an oesophageal stethoscope. The proximal part of the tube is attached to the stethoscope (Figure 1). The oesophageal tube should be positioned while listening to the heart sounds and secured in position when the heart sounds are maximal. In children, we have used a range of sizes of tubes for this purpose and found that the tube size is not of much significance in auscultating heart and breath sounds. In adults we have used comparatively larger diameter endotracheal tubes to get a longer tube for appropriate depth of insertion (2). We have found that this technique can be used in the presence of a nasogastric tube or oesophageal temperature probe.

Other techniques of making an oesophageal stethoscope such as using a nasogastric tube and the finger of a rubber glove have been described1. We have found the more rigid endotracheal tubes are easier to introduce into the oesophagus than nasogastric tubes. Compared to other oesophageal stethoscopes, when using an endotracheal tube there is no danger of dislodgement of attachments such as a glove-finger (1) or puncture of the cuff used on other oesophageal stethoscopes.

[FIGURE 1 OMITTED]

We suggest that use of an oesophageal stethoscope still has a place and that the use of an endotracheal tube placed in the oesophagus is a simple, inexpensive, readily available method which requires minimal expertise to achieve.

A. CHAKRABORTY

S. MATHUR

Varanasi, India

References

(1.) Eckhardt K, Aseno S. The individually fitted earpiece. Letter to the editor. Update in Anaesthesia 2002; 14:33.

(2.) Manecke Jr GR, Poppers PJ.Esophageal stethoscope placement depth: its effect on heart and lung sound monitoring during general anesthesia. Anesth Analg 1998; 86:1276-1279.
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Author:Chakraborty, A.; Mathur, S.
Publication:Anaesthesia and Intensive Care
Geographic Code:9INDI
Date:Apr 1, 2007
Words:413
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