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LETTER TO THE EDITOR

Lightwand-Assisted Intubation of Patients in the Lateral Decubitus Position

V. Dimitriou, MD^*, J. Brimacombe, MD, G. S. Voyagis, MD, and C. Iatrou, MD^*

*Department of Anaesthesia; University of Thrace, Greece; Department of Anaesthesia and Intensive Care; University of Queensland and James Cook University; Cairns Base Hospital, Cairns, Australia; jbrimaco@bigpond.net.au; Department of Anaesthesia; Sotiria Hospital, Greece

To the Editor:

Cheng et al. (1) showed that lightwand-assisted intubation was equally successful in the supine and lateral positions, a similar finding to our recent study using lightwand-assisted intubation via the intubating laryngeal mask airway (ILMA) (2). However, we would like to challenge the suggestion that their technique is superior to ours.

First, they state that their technique "directly saves intubation time." However, the saving of only 15 seconds was primarily related to different definitions for intubation time. Second, they state that our technique "presented complications to clinical personnel who needed to promptly intubate certain patients who were not lying in the supine position." In fact, there were no such instances. Finally, they state that "adequate ventilation via the ILMA and LMA techniques without involvement of tracheal intubation have been reported to be only 77% and 56%, respectively (3)." This figure is for inexperienced personnel and represents one of the lowest ventilatory success rates ever reported in the literature. More representative figures would be 99% for the ILMA (4) and 98% for the LMA (5).

We therefore consider these are equivalent intubation techniques; however, the ILMA may be better for airway rescue, as it allows ventilation before intubation.

References

1. Cheng KI, Chu KS, Chau SW, et al. Lightwand-assisted intubation of patients in the lateral decubitus position. Anesth Analg 2004;99:279–83.[Abstract/Free Full Text]
2. Dimitriou V, Voyagis GS, Iatrou C, Brimacombe J. Flexible lightwand-guided intubation using the intubating laryngeal mask airway in the supine, right, and left lateral positions in healthy patients by experienced users. Anesth Analg 2003;96:896–8.[Abstract/Free Full Text]
3. Choyce A, Avidan MS, Shariff A, et al. A comparison of the intubating and standard laryngeal mask airways for airway management by inexperienced personnel. Anaesthesia 2001;56:357–60.[Web of Science][Medline]
4. Brimacombe J. The intubating LMA for airway intubation. In: Laryngeal mask anesthesia: principles and practice. London: WB Saunders, 2004:469–504.
5. Brimacombe J. Maintenance phase. In: Laryngeal mask anesthesia: principles and practice. London: WB Saunders, 2004:241–63.

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