Anesth Analg 2002;95:1124-1125
© 2002 International Anesthesia Research Society
LETTERS TO THE EDITOR
Anticipated Difficult Airway: The Role of Fiberoptics
Thomas Heidegger, MD, and
Hansjörg Gerig, MD
Department of Anesthesiology, Cantonal Hospital, St. Gallen, Switzerland
To the Editor:
Sir, we read with great interest the article of Arya et al. (1) who describe a modified retrograde intubation for the management of a patient with bilateral ankylosis of the temporomandibular joint. Although they mention the unavailability of a fiberscope, we want to emphasize that this method should have been discussed. Today it is generally accepted that the fiberoptic intubation in the awake patient is a very important approach, if not even the method of choice in the management of the anticipated difficult airway (2,3). Surveys from the United States, France, and Denmark (4–6) have shown that despite the availability of different airway tools, anesthesiologists prefer to use the fiberscope as the only additional instrument for the management of the anticipated difficult airway. Therefore the demand to learn this method is evident.
References
- Arya VK, Dutta A, Chari P, Sharma RK. Difficult retrograde endotracheal intubation: the role of a pharyngeal loop. Anesth Analg 2002; 94: 470–3.[Abstract/Free Full Text]
- Practice guidelines for management of the difficult airway: a report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 1993; 78: 597–602.[ISI][Medline]
- Heidegger T, Gerig HJ, Ulrich B, Kreienbühl G. Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies—an analysis of 13,248 intubations. Anesth Analg 2001; 92: 517–22.[Abstract/Free Full Text]
- Rosenblatt WH, Wagner PJ, Ovassapian A, Kain ZN. Practice patterns in managing the difficult airway by anesthesiologists in the United States. Anesth Analg 1998; 87: 153–7.[Abstract/Free Full Text]
- Avarguès P, Cros AM, Daucourt V, et al. Management of difficult intubation by French anaesthetists and impact of the French experts conference. Ann Fr Anesth Reanim 1999; 18: 719–24.[ISI][Medline]
- Kristensen MS, Moller J. Airway behaviour, experience and knowledge among Danish anaesthesiologists: room for improvement. Acta Anaesthesiol Scand 2001; 45: 1181–5.[Medline]
Response
Virendra K. Arya, and
Amitabh Dutta
Chandigarh, India
In Response:
We fully agree with Heidegger et al. (1) regarding the use of the fiberscope as the primary additional instrument for management of anticipated difficult airway, and every anesthesiologist should have the skill to use the same. The flexible fiberscope is definitely safer, effective, and a relatively atraumatic device in experienced hands. However, in certain situations, although only a few have been reported, the fiberscope-aided attempts have failed or proven very difficult (2–4). Alternate techniques of difficult airway management, as described by us (5), may also prove useful in such scenarios in addition to a situation when a fiberscope is not available.
References
- Heidegger T, Gerig HJ, Ulrich B, Kreienbuhl G. Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies–an analysis of 13,248 intubations. Anesth Analg 2001; 92: 517–22.
- Mason RA. The obstructed airway in head and neck surgery. Anaesthesia 1999; 54: 625–8.[ISI][Medline]
- Podder S, Dutta A, Chari P. Retrolaryngeal extension of goiter in a morbidly obese patient leading to a difficult airway. Anaesthesia 2000; 55: 1219–21.[Medline]
- Kanaya N, Nakayama M, Seki S, Kawana S, Watanabe H, Namiki A. Two person technique for fiberscope aided tracheal intubation in a patient with long and narrow reteropharyngeal airspace. Anesth Analg 2001; 92: 1611–3.[Free Full Text]
- Arya VK, Dutta A, Chari P, Sharma RK. Difficult reterograde endotracheal intubation: the role of a pharyngeal loop. Anesth Analg 2002; 94: 470–3.
