If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read E-letter]](/icons/misc/sectionDOWN.gif)
Re: Video laryngoscopy and external laryngeal manipulation, direct feedback provides better glottic views
- Harald Groeben, Andrea Jungbauer, Mark Schumann, Violeta Brunkhorst, Andre Börgers (7 May 2009)
-
Video laryngoscopy and external laryngeal manipulation, direct feedback provides better glottic views
- Imran Ahmad, Cheng Ong, Velliyottillom.V.Parameswaran (21 April 2009)
|
|
|||
|
Harald Groeben, Anaesthesiologist Department of Anaesthesiology, CCM and Pain Therapy, Clinics Essen-Mitte, Essen, Germany, Andrea Jungbauer, Mark Schumann, Violeta Brunkhorst, Andre Börgers
Send letter to journal:
|
To the Editor We thank Dr. Ahmad and his co-authors for their comments and questions concerning our article.(1) Dr. Ahmad and co-authors stress the impact of an optimised view by the assistance for intubation on the success rate and time for intubation. Dr. Ahmad wants to know whether the assissting staff was allowed to share the view on the monitor of the video laryngoscope. Yes, to use the full benefit of the technique, the assisting staff was allowed to share the view on the monitor. We agree that the change from a blind assistant to a seeing one improves the success. However, with our means we can not quantify this effect. To analyse this effect a different study design would have been neccessary. For a proper analysis an adequate number of intubations with either blind or seeing assistant staff, all performed with the video laryngoscopy technique, would be neccessary. In our study the difference between the conventional technique and the improved view with the video laryngoscope was to our opinion more important than the difference in the view of the assistant staff. Overall, we think the improved view for the assistant staff contributes to the positive result, but the extend of this effect can not be analysed with our means. To clarify this question further research is required. 1. Jungbauer A, Schumann M, Brunkhorst V, Börgers A, Groeben H. Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. Br J Anaesth 2009;102:546-50. Conflict of Interest:None declared |
|||
|
|
|||
|
Imran Ahmad , Cheng Ong, Velliyottillom.V.Parameswaran
Send letter to journal:
|
Editor-- We read with interest the article written by Groeben and colleagues 1, comparing direct laryngoscopy to video laryngoscopy in expected difficult tracheal intubations. We also have used the Storz video laryngoscope in our institution and found it a very useful tool for difficult intubations and for teaching, not only for novice anaesthetists, but also for anaesthetic assistants, as they too are able to visualize the view of the glottis during external manipulation of the larynx and when applying cricoid pressure for rapid sequence inductions. We have found that the assistant is able to optimize the view of the glottis for the anaesthetist by directly visualising the view on the portable screen, and not solely rely on indirect feedback from the anaesthetist, as with conventional direct laryngoscopy. In their study, Groeben and colleagues used external manipulations to optimise the glottic view in 31 cases for the video laryngoscope group and in 20 cases for the direct laryngoscopy group, but they failed to say whether the assistant performing the external manipulation was allowed to see the view obtained on the screen in the video laryngoscope group. It would be interesting to know whether a subanalysis of this group of patients would show a significant difference in the grade of the view obtained and success of tracheal intubation, as the direct feedback obtained from the video laryngoscope allows the assistant to provide a much better and coordinated view for the anaesthetist during external laryngeal manipulation. Do the authors agree and did they consider a subanalysis of this group in their study? In the study a subanalysis of the patients with a classified airway according to Cormack and Lehane 2 grade III and IV was performed and this showed a significant difference in the intubation time, in favour of the video laryngoscope group and a significantly better rate of successful intubation (45 of 46 attempts for video laryngoscope group and 28 of 36 attempts for the direct laryngoscope group). They also found that fewer manipulations were required in this group. The authors, however, failed to state how many of the cases in this subanalysis group required external laryngeal manipulation (although the need for optimising manoeuvres was mentioned). These significant differences could be attributed to a poorer view of the glottis obtained as a result of ‘blind’ external manipulation in the direct laryngoscope group compared to the video laryngoscope group, where there is improved coordination between both the assistant and the anaesthetist as a result of the image seen on the monitor, which has been shown to result in a significant advantage over the conventional laryngoscope technique 3. In fact the study by Kaplan and colleagues found that external laryngeal manipulation in patients anticipated to have difficult airways resulted in all the cases being successfully intubated. Finally, do the authors feel that they could also conclude that the use of the video laryngoscope eases external laryngeal manipulation, especially in anticipated difficult intubation? I Ahmad* C Ong Velliyottillom.V.Parameswaran London, UK *E-mail: imran.ahmad@gstt.nhs.uk 1 Jungbauer A, Schumann M, Brunkhorst V, Borgers A, Groeben H. Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. Br J Anaesth 2009; 102: 546-50 2 Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105-11 3 Kaplan MB, Ward DS, Berci G. A new video laryngoscope—an aid to intubation and teaching. J Clin Anesth 2003; 14:620-6 Conflict of Interest:None declared |
|||