We acknowledge the comments of van Zundert and Lee1 concerning our recent article.2
As stated, difficult intubation was assessed using the intubation difficulty scale developed by Adnet et al.3 on the basis of seven variables associated with difficult intubation recorded by the anesthetist in charge of the patient. We choose intubation difficulty scale because it is an objective and validated score including intubations conditions.
The video-laryngoscope is one tool among the plethora of tools available for difficult intubation but assessment of its risk/benefit in the difficult intubation algorithm is still unclear.
We disagree with van Zundert and Lee concerning the usefulness of bedside tests. Even if they are not highly specific in predicting difficult intubation, we believe they are essential and obligatory in order to reduce the likelihood of morbidity associated with difficult airway management.
Yes, “we can’t change the physiognomy of a patient.” But the “endless efforts assessing factors which may or may not predict a difficult tracheal intubation,” must be the first step in assessment of the airway for all patients.
Vincent Minville, MD
Hélène Gonzalez, MD
Olivier Fourcade, MD, PhD
Department of Anesthesiology and Intensive Care
University Hospital of Toulouse
1.Van Zundert AAJ, Lee RA. Intubation difficulties in obese patients. Anesth Analg 2009;108:1051
2.Gonzalez H, Minville V, Delanoue K, Mazerolles M, Concina D, Fourcade O. The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg 2008;106:1132–6
3.Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL, Plaisance P, Lapandry C. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 1997;87:1290–7