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• W2033037857 abstract "We read with interest the paper by Dr Asai and colleagues (Asai et al. Anaesthesia 2000; 55: 82–5) wherein they conclude that in patients in whom stabilisation of the head and neck is required, placement of the intubating laryngeal mask (ILMA), and subsequent fibreoptic assisted intubation through it, is significantly easier and faster than tracheal intubation using a laryngoscope and gum elastic bougie. We would like to raise certain issues especially pertaining to the design of the study. The authors mention that ‘no undue force was used during laryngoscopy to avoid possible damage to the teeth or the oropharynx’. Normally, every care is taken to avoid such damage. By implication, do the authors suggest that less than adequate force was used? If less than adequate force is used then in fact difficult intubation could be simulated [1]. Manipulation of the larynx improves the view at laryngoscopy [2]; Vanner has reported that both the standard technique of cricoid pressure and that applied in an upward and backward direction were more likely to give a better view at laryngoscopy than no cricoid pressure [3]. Application of cricoid pressure is not contraindicated during manual in-line stabilisation. In the above study, views at laryngoscopy were similar in the two groups. Is it not likely that by using the above simple and commonly applied manoeuvres, views could have been improved and some of the failures in the control group in their study avoided? While on the one hand cricoid pressure was by study design avoided, on the other hand, adjustment of the position of the ILMA by manoeuvring the handle was allowed, thereby facilitating the passage of the tracheal tube. Does this not introduce bias in the study? Intubation through the ILMA was attempted in those patients in the control group in whom the tracheal tube could not be passed with the help of a bougie (n = 11). However, if intubation failed in patients in the ILMA group (n = 3), no further attempt was made to see if intubation could be achieved with a bougie. The time needed and VAS scores have not been mentioned for those patients in the control group who could not be intubated with a bougie but were subsequently intubated through the ILMA. The authors mentioned the type and size of the tube they used in the control group but not in the ILMA group. They do not mention if all the intubations in either or both groups were carried out by the same investigator and what was the level of experience at performing insertion of ILMA and fibreoptic intubations. The authors attempt to use a VAS, yet ‘failed’ intubation automatically scores 100, which is the maximum. This defeats the whole point of VAS scoring and it is not surprising that the data were highly skewed. Given the nonparametric nature of the data, it was inappropriate to use mean and standard deviation of the VAS in the power calculation. In view of their conclusions, would the authors recommend routine use of ILMA-assisted intubations instead of conventional laryngoscope and a bougie in those not at risk of aspiration of gastric contents?" @default.
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• W2033037857 date "2000-08-17" @default.
• W2033037857 modified "2023-10-09" @default.
• W2033037857 title "Intubation during manual in-line stabilisation of the head and neck" @default.
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• W2033037857 doi "https://doi.org/10.1046/j.1365-2044.2000.01629-8.x" @default.
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