Tube-in-tube airway management in a patient with Montgomery T-tube in situ -a case report-

BACKGROUND: Montgomery T-tube (MTT) is a useful airway device but is seldom used. Owing to its specific shape and structure, it is challenging for anesthesiologists to manage airway in patients with MTT in situ who require general anesthesia and continuous positive-pressure ventilation (CPPV). CASE: A 48-year-old man (weight 74 kg) with an MTT in situ was scheduled for local pancreatic resection under general anesthesia. We transorally inserted a cuffed endotracheal tube into the intratracheal limb of the MTT to achieve CPPV and to deliver the inhalation anesthetic. The endotracheal tube was removed successfully after the patient fully recovered from anesthesia. No tracheal injury or hemorrhage occurred after intubation or extubation, and the location of the MTT remained unchanged. CONCLUSIONS: Transoral insertion of a cuffed endotracheal tube into the intratracheal limb of the MTT could therefore be considered as a safe and feasible approach for airway management.