489
COVER NOTE
Kuhn's Endotracheal Tube
The evolution of endotracheal intubation for anaesthesia was a slow process, being stimulated only by the need to avoid aspiration of blood and debris during head and neck surgery. The first step was Trendelenburg's cuffed tracheotomy cannula (and Hahn's similar cannula with circumferential sponge) introduced in 1871. Both were connected by tubing to Trendelenburg's cone for maintenance of anaesthesia. In 1878 Sir William Macewen used a flexible metal tube to intubate the larynx perorally for administration of chloroform during removal of an oral tumour, but this earliest instance of true endotracheal anaesthesia went unnoticed. O'Dwyer provided the next impetus in 1882 with his laryngeal tubes developed for the treatment of diphtheritic laryngeal obstruction. In 1888 he adapted the tube so that the proximal end protruded from the mouth as aT-piece for connection to George Fell's bellows apparatus, thus enabling positive pressure ventilation. The combining of Trendelenburg's and O'Dwyer's innovations occurred to Professor Maydl and Victor Eisenmenger, both working in Prague in 1893. Maydl connected an O'Dwyer-type laryngeal cannula by rubber tube to a glass
Anaesthesia and Intensive Care, Vol. 19, No. 4, November, 1991
Trendelenburg cone, while Eisenmenger used a cuffed, hard-rubber endotracheal tube connected to a Trendelenburg cone. In both cases, the endotracheal tube was inserted manually with the aid of an oral mirror. Franz Kuhn, a head and neck surgeon working in Kassel, Germany, between 1902 and 1911, is said to have done more than any other to obtain general recognition for endotracheal anaesthesia. His tube, shown in the cover picture, is a flexible metal one, inserted on a stilette which was then withdrawn. The tube was then secured with an elastic neck strap and connected by a rubber tube to a Trendelenburg cone. The glottis was packed with oiled gauze. Franz Kuhn was also the first anaesthetist to use topical cocaine for awake intubation and the first to suggest the use of suction catheters down tracheal tubes. He also recommended nasotracheal tubes for long-term intubation because they were better tolerated. It took fifty years for endotracheal anaesthesia to progress from Trendelenburg to the work of Rowbotham and Magill: however, Kuhn's tube is probably the true forerunner of the endotracheal tube as we know it today. ROD WESTHORPE
Honorary Curator GeofJrey Kaye Museum of Anaesthetic History REFERENCES
Calverley RK. Intubation in Anaesthesia. The History of Anaesthesia, Royal Society of Medicine International Congress and Symposium Series No. 134; 1989. Duncum BM. The Development of Inhalational Anaesthesia. London: Oxford University Press, 1947. Penn HP. Catalogue of the Geoffrey Kaye Museum of Anaesthetic History. Sykes WS. Essays on the First Hundred . Years of Anaesthesia. Churchill Livingstone, London 1982; Vo!. 3.
COVER NOTE
Kuhn's Endotracheal Tube
The evolution of endotracheal intubation for anaesthesia was a slow process, being stimulated only by the need to avoid aspiration of blood and debris during head and neck surgery. The first step was Trendelenburg's cuffed tracheotomy cannula (and Hahn's similar cannula with circumferential sponge) introduced in 1871. Both were connected by tubing to Trendelenburg's cone for maintenance of anaesthesia. In 1878 Sir William Macewen used a flexible metal tube to intubate the larynx perorally for administration of chloroform during removal of an oral tumour, but this earliest instance of true endotracheal anaesthesia went unnoticed. O'Dwyer provided the next impetus in 1882 with his laryngeal tubes developed for the treatment of diphtheritic laryngeal obstruction. In 1888 he adapted the tube so that the proximal end protruded from the mouth as aT-piece for connection to George Fell's bellows apparatus, thus enabling positive pressure ventilation. The combining of Trendelenburg's and O'Dwyer's innovations occurred to Professor Maydl and Victor Eisenmenger, both working in Prague in 1893. Maydl connected an O'Dwyer-type laryngeal cannula by rubber tube to a glass
Anaesthesia and Intensive Care, Vol. 19, No. 4, November, 1991
Trendelenburg cone, while Eisenmenger used a cuffed, hard-rubber endotracheal tube connected to a Trendelenburg cone. In both cases, the endotracheal tube was inserted manually with the aid of an oral mirror. Franz Kuhn, a head and neck surgeon working in Kassel, Germany, between 1902 and 1911, is said to have done more than any other to obtain general recognition for endotracheal anaesthesia. His tube, shown in the cover picture, is a flexible metal one, inserted on a stilette which was then withdrawn. The tube was then secured with an elastic neck strap and connected by a rubber tube to a Trendelenburg cone. The glottis was packed with oiled gauze. Franz Kuhn was also the first anaesthetist to use topical cocaine for awake intubation and the first to suggest the use of suction catheters down tracheal tubes. He also recommended nasotracheal tubes for long-term intubation because they were better tolerated. It took fifty years for endotracheal anaesthesia to progress from Trendelenburg to the work of Rowbotham and Magill: however, Kuhn's tube is probably the true forerunner of the endotracheal tube as we know it today. ROD WESTHORPE
Honorary Curator GeofJrey Kaye Museum of Anaesthetic History REFERENCES
Calverley RK. Intubation in Anaesthesia. The History of Anaesthesia, Royal Society of Medicine International Congress and Symposium Series No. 134; 1989. Duncum BM. The Development of Inhalational Anaesthesia. London: Oxford University Press, 1947. Penn HP. Catalogue of the Geoffrey Kaye Museum of Anaesthetic History. Sykes WS. Essays on the First Hundred . Years of Anaesthesia. Churchill Livingstone, London 1982; Vo!. 3.
