Letters to the Editor: Letters & Announcements
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 Fastrack™ 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 χ2 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.
Akihiro Suzuki, MD, PhD
Akihito Tampo, MD
Nobuko Abe, MD
Sayuri Minami, MD
Osamu Takahata, MD, PhD
Hiroshi Iwasaki, MD, PhD
Department of anesthesiology and critical care medicine
Asahikawa medical college
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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.
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.
4. Shulman GB, Connelly NR, Gibson C. The adult Bullard laryngoscope in paediatric patients. Can J Anaesth 1997;44:969–72.
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.