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Correspondance
- Pooja Ajit Warty (11 July 2006)
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c-Trach performance and large population appraisal
- Davide Cattano (2 April 2006)
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Pooja Ajit Warty, Anaesthetist
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Editor- I would like to congratulate the authors on their study on the use of the C Trach TM- intubating LMA 1. Indeed this device appears to be a promising alternative on the horizon in the management of difficult airway. Awake fibreoptic intubation has so far been considered to be the gold standard for securing the difficult airway 2. However use of the above device requires a level of expertise and we as trainees rarely have an opportunity to use the fibreoptic bronchoscope. I feel that the LMA Ctrach is a rapid and safe alternative to the fibereoptic bronchoscope. The learning curve for skill acquisition also appears to be short. One of the advantages of the device is the fact that the patient can be ventilated at all times. The LMA TM –C Trach could be a useful intubating device when we are faced with unanticipated difficult intubation out of hours in the Accident and Emergency department. This device appears to be an ideal option to be included in our difficult intubation trolley. 1.Timmerman A, Russo S, Graph BM. The evaluation of the Ctrach TM – An intubating LMA with integrated fibreoptic system. Br J Anaesthesia 2006;96:516-22 2.Benumof JL. Management of the difficult airway with special emphasis on awake tracheal intubation. Anaesthesiology 1991;75:1087-110. Conflict of Interest:None declared |
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Davide Cattano, Clinical Instructor of Anesthesiology Washington University, St Louis, MO, USA
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Dear Editor, in the Br. J. Anaesth. 2006; 96(4)appeared the second prospective evaluation on the new video intubating laryngeal mask performance done by Timmermann and collegues [1]. Liu et al. [2] just presented their 100 patients casistic when a 60 patients assessment promplty followed. As the authors stated, a wide casistic already exists for the ILMA, but trying a comparison of succeful rates from 10 times different population size is quite negligible. As well direct laryngoscopy should not be taken in account while considering the view and the intubation success rate obtained, compared to blind technique. A final consideration should be addressed to the correct size chosen. While it is common to use adult-sex matched rule, the company still suggests a weight based guideline, it is clinically evident for the ILMA, so for the C-Trach, that an external evaluation of the airway anatomy should consistently preceed the insertion. Moreover a size variability has not been considered by the studies. A recent case report [3], while discussing the potential inability of c-Trach to visualize the "anteriorized" laryngeal inlet, shows how the size matched by the anatomy could be important (distance between oral rim and thyroid cartilage) in order to optimize the alignment. Further evaluations in large population prospective studies are necessary. [1]Timmermann A, Russo S, Graf BM. Evaluation of the CTrachTM--an intubating LMA with integrated fibreoptic system.Br J Anaesth. 2006 Apr;96(4):516-21. [2]Liu EH, Goy RW, Chen FG.The LMA CTrach, a new laryngeal mask airway for endotracheal intubation under vision: evaluation in 100 patients.Br J Anaesth. 2006 Mar;96(3):396-400. [3]Kristensen MS.The LMA CTrach for awake intubation combines the features of the LMA Fastrach and the fiberoptic bronchoscope, but cannot replace this combination in all patients.Acta Anaesthesiol Scand. 2006 Apr;50(4):526. Conflict of Interest:None declared |
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