Indications for Combitube or King Laryngeal Tube Insertion Apnea, severe respiratory failure, or impending respiratory arrest in which endotracheal intubation cannot be accomplished Certain elective anesthesia cases Situations where BVM ventilation is difficult or impossible (eg, in patients with severe facial deformity [traumatic or natural], thick beard, or other factors that interfere with the face mask seal, and in patients with upper airway blockage due to obstructing soft tissues) Contraindications to Combitube or King Laryngeal Tube Insertion Absolute contraindications There is no medical contraindication to providing ventilatory support to a patient; however, a legal contraindication (do-not-resuscitate order or specific advance directive) may be in force Restricted mouth opening that blocks tube insertion (nasotracheal intubation or a surgical airway would be indicated in this case) Impassable upper airway obstruction (surgical airway would be indicated in this case) Relative contraindications Consciousness or presence of a gag reflex Hypopharyngeal or esophageal abnormalities or trauma (which increase the risk of further local damage by a supraglottic airway) Combitube is not recommended for patients < 4 feet tall Complications of Combitube or King Laryngeal Tube Insertion Complications include Vomiting and aspiration during tube insertion or after placement in patients who regain a gag reflex Dental or oropharyngeal soft tissue trauma during tube insertion Tongue edema due to prolonged placement or balloon overinflation Equipment for Combitube or King Laryngeal Tube Insertion Gloves, mask, gown, and eye protection (ie, universal precautions) Syringes for balloon cuff inflation Sterile water-soluble lubricant or anesthetic jelly Combitube or King laryngeal tube, appropriately sized to patient Oxygen source (100% oxygen, 15 L / minute) Suctioning apparatus to clear the pharynx as needed Pulse oximeter, capnometer (end-tidal carbon dioxide monitor), and appropriate sensors Drugs to aid intubation Equipment for alternate methods of airway control should insertion fail (eg, laryngeal mask airway, bag-valve-mask ventilation, endotracheal intubation, cricothyrotomy) Additional Considerations for Combitube or King Laryngeal Tube Insertion The balloon cuffs of the Combitube are inflated individually.