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Conventional Tracheal Tubes for Intubation through the Intubating Laryngeal Mask Airway

Kundra, Pankaj; Sujata, N; Ravishankar, M

doi: 10.1213/01.ANE.0000173752.30351.9D
Letters to the Editor: Letters & Announcements
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Department of Anaesthesiology and Critical Care; JIPMER; Pondicherry, India; p_kundra@hotmail.com

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In Response:

Silicone-reinforced tracheal tubes are the best option to secure a difficult airway through the intubating laryngeal mask airway when available. However, when silicone tube is not available, a prewarmed PVC tube provides a useful option. Securing the airway in difficult conditions is of prime concern and unavailability of the silicone tube should not deter the anesthesiologist from using an available PVC tube.

In vitro measured forces on distal objects do provide useful guidelines to the use of different tracheal tubes. Nevertheless, during tracheal intubation through the intubating laryngeal mask airway, excessive pressures should be avoided whenever the tracheal tube encounters resistance. The adjustments are made in obtaining a proper alignment of the intubating laryngeal mask airway with the glottis rather than trying to force the tracheal tube into the glottis. Incidence of trauma can be significantly reduced if the anesthesiologist gently performs blind tracheal intubation.

Use of fiberoptic laryngoscope for a difficult airway is ideal, but its availability at all times of difficulty cannot be guaranteed. Alternative methods should be encouraged when fiberoptic endoscopes are not available. Less expensive alternatives are available and have proven their efficacy in times of need with a satisfactory success rate.

Again, we appreciate the concerns raised and thank the editor for giving us an opportunity to reply.

Pankaj Kundra

N. Sujata

M. Ravishankar

Department of Anaesthesiology and Critical Care

JIPMER

Pondicherry, India

p_kundra@hotmail.com

© 2005 International Anesthesia Research Society