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Re: Airway parameter assessment and difficult LMA insertion
- Tao Zhu (20 February 2009)
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Airway parameter assessment and difficult LMA insertion
- Prasad K Narasimha (13 February 2009)
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Tao Zhu Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu Sichuan Province
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We thank Drs. Narasimha for his comments. Short thyromental distance has been associated with difficult direct laryngoscopy;1 but not been shown to be associated with difficult LMA-Fastrach guided intubation.2 We did not provide the data for the hoarseness because of no incidence in the two groups but appreciate Drs. Narasimha for raising this issue. References 1, Patil VU, Stehling LC, Zaunder HL, eds. Fiberoptic Endoscopy in Anesthesia. Chicago, Year Book Medical, 1983, p 79 2, Wender R, Goldman AJ. Awake insertion of the fibreoptic intubating LMA CTrach in three morbidly obese patients with potentially difficult airways Anaesthesia 2007 62 (9):948 - 951 Zhu Tao, MD Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu Sichuan Province Xwtao.zhu@gmail.com Conflict of Interest:None declared |
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Prasad K Narasimha, Associate professor, Dept of Anaesthesiology Kasturba medical college, Manipal
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Dear Sir, We read this interesting study done by L. Ye, J. Liu and colleagues who compared two techniques of tracheal tube orientation for successful intubation through the intubating LMA in Mallampati class 3 and 4 patients. It is true that insertion of the endotracheal tube with the natural curve directed opposite to the curvature of the ILMA results in more successful intubation as the chances of the tube hitching against the anterior structures of the glottic inlet is minimised. The chance of difficulty in endotracheal intubation through the ILMA is increased if structures of the glottis are more anterior than usual. Difficulty in endotracheal tube placement due to anterior glottis is more consistent in patients who have a smaller thyromental distance. It would have been appropriate if the study included of evaluation of this airway parameter than Mallampati as it is not always consistent with difficult LMA placement or intubation through the LMA. Incidence of sore throat would assess the insult caused by supraglottic devices placed in the oropharynx. Damage or trauma to the glottic and infraglottic structures would cause hoarseness or stridor due to mucosal damage and / or oedema. However since blind insertion of endotracheal tube was done through ILMA in this study, it would be appropriate if the incidence of hoarseness was assessed. Conflict of Interest:None declared |
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