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Assistant Professor of Anesthesia and Critical Care University of Chicago Chicago, IL
To the Editor:
Although Stix et al. (1) are to be congratulated for executing a successful endotracheal tube exchange in a challenging patient, one wonders whether the complexity of the procedure (and the attendant risk of that complexity) was warranted. The patient had already undergone two successful, uneventful direct laryngoscopies, including one for placement of a double lumen tube (DLT). In the absence of any conditions such as new edema or bleeding, an exchange of the DLT for a single lumen tube (SLT) under direct vision should have been expected to be similarly uneventful. The authors’ approach to tube exchange, which included placement of an intubating LMA altered by removal of the epiglottic elevator, was novel, but in this particular case, seems to be more trouble than it was worth. Indeed, at one point, the patient had a DLT, an LMA, an airway exchange catheter, and a fiberoptic bronchoscope in his airway all at the same time!
If the initial exchange of the SLT for the DLT had gone smoothly as described, then the rationale for this complicated second exchange remains unclear. Having multiple contingency plans for a failed technique is laudable, but complexity often adds risk (2). It is usually best to "keep it simple."
References
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