while an assistant railroaded a size 2.5 ETT over the guidewire. Tracheal placement of the ETT was confirmed using capnography. The removed ETT was found to be partly blocked. The surgery was performed uneventfully thereafter and tracheal extubation was performed at the completion of surgery. The guidewire of CVP line has the following properties which make it a suitable choice for neonatal tube change in difficult cases: it is atraumatic, sufficiently long (50 cm), and rigid allowing the ETT to be railroaded over it and its external diameter is small allowing it to be useful to change ETT as small as size 2.5. To the best of our knowledge, tube changers for a size 2.5 ETT are not available. Thus in absence of commercially available tube changers and fiberoptic scope, the guidewire of a CVP line can be used selectively in difficult pediatric cases; the disadvantage of not being able to supplement oxygen seem to be smaller than the advantage of being able to change ETT with small internal diameters in difficult cases which require urgent ETT change. Rajeev Sharma Department of Anesthesiology and Intensive Care, Maulana Azad Medical College and associated Lok Nayak Hospital New Delhi, India (email: rajeevkrsharmaji@gmail.com) References 1 Faberowski W, Lisa Charles N. Utility of airway exchange catheters in pediatric patients with a known difficult airway. Pediatr Crit Care Med 2005; 6: 454–456. 2 Kumar V, Lazar HL. Extubation of the patient after a difficult intubation. Ann Thorac Surg 1998; 65: 1778–1780. Mucous extractor: a pocket size, disposable, portable emergency suctioning device doi:10.1111/j.1460-9592.2008.02766.x SIR IR—Mucous extractors have long been used in pediatric practice but their role in an anaesthesist’s armentorium has never been highlighted. We describe an unusual case scenario in which a mucous extractor was used success- fully to suction out regurgitated material from the oropharynx of a patient and preventing aspiration pneu- monitis when no other suction device was working. A 5-year-old, ASA grade 1 male child was operated for urethroplasty under general anesthesia at Lok Nayak Hospital, New Delhi, India. Intraoperative period was uneventful and tracheal extubation was performed after clinical neuromuscular recovery. Immediately after extu- bation he started to regurgitate bilious material. A head down tilt was given immediately and suctioning tried but the vacuum pressure was found to be zero. We tried foot pump suction but it was not working. Immediately a mucous extractor was taken and oropharyngeal suctioning started. Our assistant took another mucous extractor and he also started suctioning .We suctioned a total of 50 ml bilious material from the oropharynx. The regurgitation stopped by then. The patient was maintaining saturation and his chest was clear on auscultation. He was kept under observation in the postoperative ward. No clinical or radiological evidence of aspiration pneumonitis was pres- ent and he was discharged subsequently. We had checked the suction preoperatively and it was functional but we forgot to check the foot pump suction as we do not use it routinely. Later we found that the electrical wiring of the suction had got loose within the plug and the foot pad of the foot pump suction was found to be broken. Aspiration pneumonitis remains one of the most fear- some complications during perioperative period when the airway reflexes are weak. Mucous extractors are an integral part of pediatric practice (1), but they can sometimes be helpful in anaesthesia practice also. They are small and portable. They provide effective suctioning and the suctioned material is collected in the chamber which can be emptied also. Although there is a small risk that the operator ingests some aspirate, but benefits of a saved life cannot be compared to small risk of infection. Another limitation of the mucous extractor is inability to suction out thick particulate material because of smaller pressure generated compared with our routine suctions. Inspite of the above limitations they can be beneficial upon selective use in cases like ours. Thus we feel that although such situations are uncom- mon; mucous extractors can be helpful in anesthesia practice as a pocket size, disposable, portable emergency suctioning device. Rajeev Sharma Department of Anesthesiology and Intensive Care, Lok Nayak Hospital and associated Maulana Azad Medical College, New Delhi, India (email: rajeevkrsharmaji@gmail.com) Reference 1 Cockburn. Resuscitation of the newborn. Br J Anaesth 1971; 43: 886–902. Bite blocks for use in pediatric anesthesia doi:10.1111/j.1460-9592.2008.02769.x SIR IR—In the unconscious and intubated child, it is neces- sary to maintain the passage of endotracheal tube. Biting 1258 CORRESPONDENCE Ó 2008 The Authors Journal compilation Ó 2008 Blackwell Publishing Ltd, Pediatric Anesthesia, 18, 1211–1281