Letters to the Editor: Letters & Announcements
To the Editor:
We read with interest Dr. Rajan's comments (1) on the recent letter by Craker et al. (2). At our institution we have been using the Aintree catheter for many months in the “the cannot intubate, can ventilate” scenario (3), achieving a 100% success in more than 50 cases without complications. Given our experience, we feel that some of Dr. Rajan's comments are unduly negative. For instance, we have not experienced the difficulties he mentions related to the 56-cm long catheter. Our view is that this length is adequate for removing the laryngeal mask airway (LMA) while keeping the catheter in the trachea. Similarly, his concerns about kinking and catheter dislodgement are not reflected in our experience. Finally, with respect to his concerns about difficulties with bronchoscopy, in two instances in which we were not able to visualize the vocal cords using a 4-mm fiberscope after placement of the LMA, when we removed and reinserted the LMA, we had a clear view of the laryngeal inlet.
Finally, note that using a connector to allow mechanical ventilation permits one to carry out this technique with minimal assistance, a valuable consideration in settings where another set of skilled hands may not be available. Use of the Aintree catheter has now become a technique of choice at our institution, and we heartily recommend it to others.
Andrew Zura, MD
D. John Doyle MD, PhD
Rafi Avitsian, MD
Michael DeUngria, MD
Department of General Anesthesiology
Cleveland Clinic Foundation
1. Rajan GR. Introducer catheter for fiberoptic intubation does exist. Anesth Analg 2006;102:329–30.
2. Craker L, Allan B, Lim M. Introducer catheter for fiberoptic intubation does exist. Anesth Analg 2006;102:329.
3. Zura A, Doyle DJ, Orlandi M. Use of the Aintree intubation catheter in a patient with an unexpected difficult airway. Can J Anaesth. 2005;52:646–9.