Evaluation of the LMA CTrach
Pisa, Italy
* E-mail: cattanod{at}wustl.edu
Editor—The recent article of Liu and colleagues1 added valuable experience to the mechanisms involved in poor views using the new video-assisted ILMA CTrach. However, they did not address the need for a better-designed mask size for male adults, especially for obese and more than 170 cm height patients. In our experience of 15 consecutive adult patients [height 165 (SD 5)cm; 11F/4M] undergoing bariatric surgery [BMI 43.5 (6.5)], one patient had difficult ventilation and two patients required repositioning for optimal ventilation, and three had difficult intubation through the CTrach which was resolved by direct laryngoscopy. All these patients were male. In three patients, blind intubation was performed because of difficulties in visualizing the glottis besides proper handling. The positioning of the LMA was performed by two experienced anaesthetists, used the ILMA and applying all the manouvres necessary to accomplish a good positioning of the mask. Although the ability to ventilate anaesthetized patients through the CTrach has been successful in most studies, its rate of success in visualizing the laryngeal inlet and the appropriate length of the connector at the labial rim remain as problems. The small number of patients does not allow us to make any significant conclusion, but from a clinical point of view, we suggest a revision of the CTrach conformation2 to allow for anatomical variations in the ‘big adult’ is due.
Singapore
* E-mail: analiue{at}nus.edu.sg
Editor—We thank Dr Cattano and his colleagues for their interest in our work. We understand their concerns about the need for a suitable CTrach mask for tall, obese male patients, although the need in our population is less pressing. We had, in fact, discussed such a requirement with the company after our earlier work. Our understanding is that they are working on a modified size 5 CTrach airway of suitable tube length and curvature specifically for such patients. We look forward to this development.
References
1 Liu EHC, Goy RWL, Chen FG. (2006) An evaluation of poor LMA CTrachTM views with a fibreoptic laryngoscope and the effectiveness of corrective measures. Br J Anaesth 97:878–82.
2 Dhonneur G, Ndoko SK, Yavchitz A, et al. (2006) Tracheal intubation of morbidly obese patients: LMA CTrach vs direct laryngoscopy. Br J Anaesth 97:742–5.
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  E. H. C. Liu A LMA CTrachTM for large patients Br. J. Anaesth., August 1, 2008; 101(2): 284 - 285. [Full Text] [PDF]
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