Sir,Presence of dense beard in patients is often not welcomed by anaesthesiologists. Some people wear beard for religious reasons, while others consider it an insignia of respect, and as a result they do not consent to shave even on life threatening medical grounds. Besides posing a difficulty during ventilation and intubation, facial hair also limit reliable tube fixation.[1] The adhesive tape, used commonly, cannot stick on such patients. Other methods such as tying around neck with gauze bandage or plastic tubing may lead to venous return obstruction in neck veins. Moreover, visibility of tube is also obscured by the beard. Intraoperative repositioning of obscured endotracheal (ET) tube is cumbersome.[23] Anesthesiologists have tried diverse methods, such as use of sterile drapes, oxygen tubing and surgical sutures, for the purpose.[4]We present an innovative way of fixing the ET tube in such bearded individuals by using easily and commonly available material. We administered anesthesia to a 65-year-old male patient, with a beard, for percutaneous nephrolithotomy. The patient's positioning for the procedure posed a high risk of tube displacement and difficult accessibility of the tube during the procedure. A 500 ml plastic bottle of an intravenous fluid was cut open into a rectangular piece. A centre slit of approximately the diameter of the ET tube was cut out. Two side holes were cut near the longitudinal margin [Figure 1a]. It was ensured that the side holes were not very near the margin as they could cut through the plastic. After intubation of the trachea, the tube was temporarily secured with the bandage. Thereafter, the tube was engaged into the slit of the rectangular piece [Figure 1b]. The tube was secured using tape over the plastic rectangle [Figure 1c]. Next, the whole unit consisting of the rectangular piece and tube was secured using the bandage tied to the side holes on the rectangular piece [Figure 1d]. The benefit of using the rectangular shaped plastic was that it served as a smooth surface over the beard to secure the tube. This technique can be used safely to secure the airway of individuals with beard without any risk.
Figure 1