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LETTER TO THE EDITOR

Laryngeal Exposure Using the Flexiblade^TM Laryngoscope

Department of Anesthesiology, Advocate Illinois Masonic Medical Center; Chicago, Illinois; Elorbany2000{at}yahoo.com

To the Editor:

Cheung et al. (1) compared the laryngeal view when they used either the Flexiblade^TM or the Macintosh laryngoscope blades in anesthetized adults. Their conclusion that the Flexiblade allows better visualization than the Macintosh is not supported by their own results. According to the authors, in 200 patients no single view obtained with the Macintosh was worse than the ones obtained with the Flexiblade, without lever activation. On the contrary, they found that laryngoscopic views with the Macintosh blade were significantly better than those with the Flexiblade, before lever activation (83 views or 41.5%). But, in only 38 patients (19% of the cases studied) was the view worse with the Macintosh than with the Flexiblade, with the lever activated. Thus in 162 patients (81%) the view was either similar (161 patients) or better (one patient).

These results do not support their conclusion. Nineteen percent is a very small percentage to happen by chance. Moreover, the fact that they used additional aids to accomplish tracheal intubation regardless of which blade they used renders doubtful the claim that one blade is clinically superior to the other. In addition, the authors did not mention how they controlled the lifting force of each blade; applying more lifting force with the Flexiblade could bias the results in its favor (2). Finally, the authors’ study was not blinded. I understand blinding may be impossible, especially when the change and effect occur simultaneously in the same anatomical area, but the authors should have discussed the lack of blinding as a possible source of bias.

REFERENCES

1. Cheung RW, Irwin MG, Law BC, Chan CK. A clinical comparison of the Flexiblade^TM and Macintosh laryngoscopes for laryngeal exposure in anesthetized adults. Anesth Analg 2006;102:626–30.[Abstract/Free Full Text]
2. Bucx MJ, Scheck PA, Van Geel RT, et al. Measurement of forces during laryngoscopy. Anesthesia 1992;47:348–51.[Web of Science][Medline]

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