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LETTER TO THE EDITOR

Introducer Catheter for Fiberoptic Intubation Does Exist

Department of Critical Care, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom, lloydcraker{at}doctors.org.uk

To the Editor:

Rajan (1) rightly highlights the lifesaving potential of fiberoptic intubation through a laryngeal mask airway (LMA) in the case of unexpected difficult intubation. We would, however, like to comment upon two points.

Firstly, Rajan incorrectly asserts that "there is currently no reliable introducer guide available that can be used to accomplish wire-guided intubation." In fact the Aintree intubating catheter (2,3) (Cook Critical Care, Bloomington, IN) has been successfully used in our hospital for some time, and we believe that this performs the same task as described by Rajan, perhaps with much less complexity. This is a specifically designed airway exchange catheter that fits over the fiberoptic intubating laryngoscope. Having positioned an LMA, the fiberoptic intubating laryngoscope can be passed into the trachea. The laryngoscope and LMA can then be safely removed leaving the Aintree catheter in situ, without the risk of the catheter being dislodged from the airway. An endotracheal tube of any size can then be passed over the Aintree catheter while oxygenation continues via its Rapi-fit® connector.

Secondly, we would question the wisdom of modifying equipment and its use beyond that for which it was designed. In the UK, such unlicensed use is expressly forbidden by the Medicines and Healthcare products Regulatory Agency (4), and we feel such use so would have medico-legal consequences for the anesthesiologist.

References

1. Rajan GR. Fibreoptic wire-guided transoral and through the LMA intubation technique using modified gum elastic bougie. Anesth Analg 2005;100:599–600.[Free Full Text]
2. Atherton DP, O'Sullivan E, Lowe D, Charters P. A ventilation-exchange bougie for fibreoptic intubations with the laryngeal mask airway. Anaesthesia 1996;51:1123–1126.[Web of Science][Medline]
3. Cook Critical Care. Aintree Intubating Catheter. Available at: http://www.cookgroup.com/cook_critical_care/discip/anesthes/2_09/2_09_01.html.
4. Medicines and Healthcare Products Regulatory Agency (MHRA). Device Bulletin 9801: Medical devices and equipment management for hospital and community based organisations. Available at: http://www.mhra.gov.uk.

This article has been cited by other articles:

				A. Zura, D. J. Doyle, R. Avitsian, and M. DeUngria More on intubation using the aintree catheter. Anesth. Analg., September 1, 2006; 103(3): 785 - 785. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Craker, L. Articles by Lim, M. Search for Related Content PubMed PubMed Citation Articles by Craker, L. Articles by Lim, M.