To the Editor:—Diagnostic and therapeutic fiberoptic bronchoscopy under topical anesthesia in a patient whose lungs require ventilation using continuous positive airway pressure (CPAP) but in whom the trachea is not intubated, is not easily performed because of difficulties in ensuring an airtight breathing system equipped with oxygen and a PEEP/CPAP valve. Failure to administer CPAP even for a short period may lead to severe hypoxemia. When a Patil-Syracuse mask is not available and positive pressure ventilation and/or oral fiberoptic intubation are necessary, the simple system described by Higgins and Marco  can be used.
We adopted their method to enable the application of CPAP during fiberoptic bronchoscopy. A large endotracheal tube (ETT), size 9 or 10, is cut short, the tube's cuff is inflated within the connector orifice of a face mask to form a seal (Figure 1), and the ETT is attached to an anesthetic machine equipped within a PEEP valve.
The fiberoptic bronchoscope is inserted through a fiberoptic bronchoscope swivel connector (Portex, United Kingdom) into the ETT and, from there, into the patient's nose or mouth. The face mask is kept tightly applied to the face, while the patient receives continuous oxygen and the desired PEEP.
With this simple technique, we are able to maintain the patients' prebronchoscopy oxygenation and avoid further worsening of the pulmonary disorder.
David Soroker, M.D., Chairman, Department of Anesthesia, Tiberiu Ezri, M.D., Staff Anesthesiologist, Peter Szmuk, M.D., Staff Anesthesiologist, Department of Anesthesiology, Kaplan Hospital, Rehovot, Israel.
(Accepted publication December 8, 1994).