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Anesth Analg 2007;104:1307
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000260559.47383.db

LETTER TO THE EDITOR

Section Editor:
Lawrence Saidman

The LMA FastrackTM Endotracheal Tube Facilitates the Use of the Bullard Laryngoscope

Akihiro Suzuki, MD, PhD, Akihito Tampo, MD, Nobuko Abe, MD, Sayuri Minami, MD, Osamu Takahata, MD, PhD, and Hiroshi Iwasaki, MD, PhD

Department of anesthesiology and critical care medicine, Asahikawa medical college, Asahikawa, Japan, masuikasuzuki{at}yahoo.co.jp

To the Editor:

The Bullard laryngoscope (BL) can be useful in management of the difficult airway. When the endotracheal tube (ETT) is advanced over the original BL stylet, the ETT sometimes makes contact with structures around the vocal cords, especially the right arytenoid (1). Many techniques have been advocated to make intubation with the BL easier (1–4). A similar problem also occurs with flexible fiberoptic intubation and it has been shown that the LMA FastrackTM ETT (FT), which has a unique molded silicon tip, passes easier through the glottis during fiberoptic intubation compared with a standard ETT (5). We therefore tested the use of the FT to evaluate if it might improve ETT passage with the BL.

After obtaining IRB approval and written informed consent, 40 patients scheduled for elective anesthesia were randomly assigned into group ST (standard reinforced tube) or group FT. The two tubes used have the same internal (7.5 mm) diameter, but slightly different outer (ST: 10.2 vs FT: 10.4 mm) diameters. The time required to achieve successful ETT placement after obtaining the best laryngeal view and the incidences of tube contact with the arytenoids were recorded. Unpaired Student’s t-test and the {chi}2 test were used where appropriate and P < 0.05 was considered significant.

Although the tube was larger in the FT group, incidences of tube contact with the right arytenoid were similar (11/20 in FT vs 10/20 in ST) and use of the FT reduced from 13 ± 5 to 8 ± 4 s (P = 0.02) the time required for successful ETT placement after the best laryngeal view was obtained. The overall time required to place the tube was ~41 versus ~35 s using the ST and FT tubes respectively (NS).

It seems the FT’s soft and hemispherical tip tends to help glide the tube into the trachea without resistance even if it makes contact with the arytenoids.

REFERENCES

  1. Katsnelson T, Farcon E, Schwalbe SS, Badola R. The Bullard laryngoscope and the right arytenoid. Can J Anaesth 1994;41:552–3.[Free Full Text]
  2. Baraka, A, Muallem M, Sibai AN. Facilitation of difficult tracheal intubation by the fiberoptic Bullard laryngoscope. Middle East J Anesthesiol 1991;11:73–7.[Medline]
  3. Cooper SD, Benumof JL, Ozaki GT. Evaluation of the Bullard laryngoscope using the new intubating stylet: comparison with conventional laryngoscopy. Anesth Analg 1994;79:965–70.[Abstract/Free Full Text]
  4. Shulman GB, Connelly NR, Gibson C. The adult Bullard laryngoscope in paediatric patients. Can J Anaesth 1997;44:969–72.[Abstract/Free Full Text]
  5. Greer JR, Smith SP, Strang T. A comparison of tracheal tube tip designs on the passage of an endotracheal tube during oral fiberoptic intubation. Anesthesiology 2001;94:729–31.[ISI][Medline]




This Article
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press