| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Department of Anaesthetics, Freeman Hospital, Newcastle-upon-Tyne, UK
To the Editor:
I read the case report by Dimaculangan et al. (1) with interest. I feel it is important to point out an inconsistency in the title and subsequent text. The title "Difficult Airway in a Patient with Coffin-Siris Syndrome" is at odds with the comments "easy manual ventilations" and "mask ventilation was easily accomplished." In such cases, it is useful to differentiate between a difficult intubation and a difficult airway (which this was not), particularly for the benefit of the next anesthetist.
I noted also that fiberoptic intubation during general anesthesia or use of the intubating laryngeal mask were unavailable despite the original plan apparently being awake fiberoptic intubation, in a patient highly suspicious of being a difficult intubation, for an elective procedure. I would suggest that an appropriate technique for difficult intubation in an uncooperative patient with a known easy airway might be a fiberoptic intubation with the patient asleep and breathing spontaneously.
References
SUNY-HSC at Brooklyn, Long Island College Hospital, Brooklyn, NY
In Response:
The point about difficult airway versus difficult intubation is well taken and we concede the point.
Regarding choice of intubation technique, the dentists had requested nasotracheal intubation to facilitate the performance of their planned dental procedure. We had induced general anesthesia and had to ventilate the patient via a mask. After multiple attempts at nasotracheal intubation, the conditions of the airway became less than optimal to perform a fiberoptic technique. An intubating laryngeal mask airway (LMA) was also available. What we meant to say was that, orotracheal intubation (using the LMA) was minimally acceptable to the surgeons and was not the ideal choice for the surgical procedure they planned.
We did mention that, in retrospect, we could have induced general anesthesia, maintained spontaneous respirations, and performed a fiberoptic technique at the onset.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
