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LETTER TO THE EDITOR

Lightwand-Assisted Intubation of Patients in the Lateral Decubitus Position

Kuang-I Cheng, MD^*, Koung-Shing Chu, MD, Siu-Wah Chau, MD^*, and Chao-Shun Tang, MD^*

*Department of Anesthesiology; Kaohsiung Medical University; Kaohsiung, Taiwan; kuaich{at}kmu.edu.tw Department of Anesthesiology; Kuo General Hospital; Tainan, Taiwan; Republic of China

In Response:

Using lightwand-assisted intubation via the intubating laryngeal mask airway (ILMA) or lightwand-assisted intubation directly has been demonstrated to successfully establish patient airway patency under supine or lateral position (1,2).

Dimitriou et al.'s (1) description of the technique of lightwand-assisted intubation via the ILMA did incorporate two separate aspects: the initial insertion of the ILMA apparatus, followed by the subsequent lightwand-guided intubation. Here, we are trying to use lightwand-assisted intubation directly, eliminating the procedure of insertion of the ILMA apparatus, and we were successful. In addition, there is no obvious difference of intubating-related data in comparison with ours. Lightwand-assisted intubation directly provides a rapid and safe technique to establish airway patency for patients lying in a number of different positions including the supine, left, or right lateral positions. In addition, it is not complicated for clinical personnel, whether they are residents or attending medical personnel.

The intubating time was counted from the left hand opening the mouth, insertion of the assembly into trachea, removal of the wand from the tracheal tube following correct placement of the ETT, to connecting the respirator. Both the techniques of lightwand-assisted intubation directly or using lightwand-assisted intubation via the ILMA provide fast intubation in acceptable intubation time. I cannot determine if there are any advantages of saving 15 seconds in this study. In actuality, there are many things to do for resuscitation for these 15 seconds.

There are some conflicting data on spontaneous or mechanical ventilation while patients are in supine position with LMA or ILMA (3–5). There is no adequate data to prove the benefit of ILMA or LMA while patients were ventilated under lateral position (6–8). However, it is true that I stated the results of ventilation via the ILMA and LMA from inexperienced personnel initially. Actually, I want to emphasize the problem of air leakage. Therefore, we discussed about the novice and attending investigator in the next paragraph.

I cannot agree more with Dimitriou et al. when they stated "the ILMA may be better for airway rescue, as it allows ventilation before intubation." However, we have to keep in mind that, while using ILMA or LMA, some patients still failed to establish patent airway in the lateral position (6–7). Under such a condition, the simple and easy method using a face mask to maintain airway patency should be used.

References

1. 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]
2. 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]
3. Reissmann H, Pothmann W, Fullekrug B, et al. Resistance of laryngeal mask airway and tracheal tube in mechanically ventilated patients. Br J Anaesth 2000;85:410–6.[Abstract/Free Full Text]
4. Agro F, Brimacombe J, Carassiti M, et al. The intubating laryngeal mask: clinical appraisal of ventilation and blind tracheal intubation in 110 patients. Anaesthesia 1998;53:1084–90.[Web of Science][Medline]
5. Devitt JH, Wenstone R, Noel AG, O'Donnell MP. The laryngeal mask airway and positive-pressure ventilation. Anesthesiology 1994;80:550–5.[Web of Science][Medline]
6. Chen CH, Lin CC, Tan PP. Clinical experience of laryngeal mask airway in lateral position during anesthesia [in Chinese]. Acta Anaesthesiol Sin 1985;33:31–4.
7. Komatsu R, Nagata O, Sessler DI, Ozaki M. The intubating laryngeal mask airway facilitates tracheal intubation in the lateral position. Anesth Analg 2004;98:858–61.[Abstract/Free Full Text]
8. Dimitriou V, Voyagis GS. Use of the intubating laryngeal mask for airway management and light-guided tracheal intubation in the lateral position. Eur J Anaesthesiol 2000;17:395–7.[Web of Science][Medline]

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