RAE North Pole Endotracheal Tube Indications
Primary Indications
RAE (Ring-Adair-Elwyn) North pole endotracheal tubes are specifically indicated for oral and maxillofacial surgeries where the surgical field is in or around the mouth, requiring the tube and breathing circuit connections to be positioned away from the operative site.
The preformed curved design of the RAE tube allows the connector to exit at the chin or forehead level, keeping anesthesia equipment out of the surgeon's working area 1.
Specific Clinical Applications
Oral and Maxillofacial Surgery
- Dental procedures requiring general anesthesia with nasotracheal intubation, where the preformed nasal RAE tube provides optimal positioning 2, 3
- Maxillofacial surgical procedures where standard endotracheal tubes would interfere with surgical access 4
- The tube's design facilitates unobstructed surgical access while maintaining secure airway control 2
Pediatric Considerations
- RAE tubes are commonly used in pediatric dental surgery under general anesthesia 3
- Critical positioning concern: In pediatric patients, cuffed nasal RAE tubes have 7 times higher odds of problematic placement (within 0.5 cm of carina) compared to uncuffed tubes, requiring careful attention to depth 3
- The tube tip should be kept at least 0.5 cm above the carina to avoid complications 3
Important Technical Considerations
Tube Selection and Positioning
- For nasotracheal intubation with nasal RAE tubes, the North Polar tube design may reduce epistaxis compared to spiral tubes due to its velvet-soft polyvinyl chloride material 4
- The preformed curve requires less manipulation during insertion, including reduced need for laryngeal compression (Sellick maneuver) and head position changes 4
Limitations in Specific Procedures
- Avoid RAE tubes for EBUS-TBNA procedures targeting higher paratracheal lymph nodes (stations 1, 2R, 2L, and 3P), as the endotracheal tube placement may block ultrasonographic visualization of these structures 1
- If an endotracheal tube must be used for EBUS-TBNA, a minimum size of 8.0 is required to accommodate the bronchoscope diameter 1
Common Pitfalls to Avoid
Depth Assessment Challenges
- Repositioning based on tube markings at the incisors is highly inaccurate, achieving only 50-58% of the intended adjustment, with a mean difference of 1.55 cm from planned intervention 5
- Always obtain follow-up chest radiograph after any tube repositioning to verify actual position 5
- The preformed curve of RAE tubes can make depth assessment more challenging than standard tubes 3
Securing and Monitoring
- After placement, secure the tube with tape or commercial holder avoiding compression of neck vessels that could impair venous return 6, 7
- Document the depth at the teeth/gums before securing and verify position with waveform capnography and chest X-ray 6, 7
- Re-verify tube position after any patient movement or transport, as movement is the most important factor associated with unplanned extubation 7