Anticipated Difficult Airway: The Role of Fiberoptics
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.
Thomas Heidegger, MD
Hansjörg Gerig, MD
1. Arya VK, Dutta A, Chari P, Sharma RK. Difficult retrograde endotracheal intubation: the role of a pharyngeal loop. Anesth Analg 2002; 94: 470–3.
2. 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.
3. 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.
4. 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.
5. 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.
6. Kristensen MS, Moller J. Airway behaviour, experience and knowledge among Danish anaesthesiologists: room for improvement. Acta Anaesthesiol Scand 2001; 45: 1181–5.