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LETTER TO THE EDITOR

Relying on Just a Few Predictors of Easy Airway Management May Bite Back¡

Department of Anesthesia; Queen Elizabeth II Health Sciences Centre Halifax; Nova Scotia, Canada; jlaw{at}dal.ca

To the Editor:

Khan et al.1 describe application of the upper lip bite test to a patient with a "questionable airway." We agree with Khan that successful prediction of difficult tracheal intubation will increase with the inclusion of more examined parameters.2,3 More important, and not acknowledged by Khan, however, was the presence of multiple predictors of difficulty in other aspects of airway management,4 in particular, bag-mask ventilation (obesity, history of obstructive sleep apnea,5,6 potentially decreased chest wall compliance), and difficult or impossible airway access through the cricothyroid membrane. Thus, while the authors may have (correctly, as it turns out!) predicted successful laryngoscopic intubation, had that intubation in fact not been easy, attempted reoxygenation via bag-mask ventilation or other rescue devices including emergency cricothyrotomy may have been difficult or even impossible, leading to a "can't intubate, can't oxygenate" situation. With difficulty anticipated in these fallback options, as the authors astutely point out, the more prudent course of action for this patient would have been awake tracheal intubation, cooperation permitting.

REFERENCES

1. Khan ZH, Gharabaghian M, Ferozeh N, Ghiamat M, Mohammadi M. Easy endotracheal intubation of a patient suffering from both Cushing's and Nelson's Syndromes predicted by the upper lip bite test despite a Mallampati class 4 airway. Anesth Analg 2007;105:786–7[Abstract/Free Full Text]
2. El-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996;82:1197–204[Abstract]
3. Arne J, Descoins P, Fusciardi J, Ingrand P, Ferrier B, Boudigues D, Aries J. Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index. Br J Anaesth 1998;80:140–6[Abstract/Free Full Text]
4. Murphy M, Hung O, Launcelott G, Law JA, Morris I. Predicting the difficult laryngoscopic intubation: are we on the right track? Can J Anaesth 2005;52:231–5[Web of Science][Medline]
5. Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, Riou B. Prediction of difficult mask ventilation. Anesthesiology 2000;92:1229–36[Web of Science][Medline]
6. Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation J Anesth 2005;19:7–11[Medline]

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 Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Law, J. A. Search for Related Content PubMed PubMed Citation Articles by Law, J. A.