Xue et al.1 correctly point out that the liquid crystal display monitor of the Airway Scope (AWS) is difficult or impossible to use in bright sunlight, a limitation originally described by Nao et al.2 That the AWS may fail in bright sunlight is highly relevant to an article about prehospital use of the device and should have been mentioned in our recent report.3
The transreflective screen on the GlideScope Ranger presumably provides better visualization under direct sunlight. But as was reported by Cooper et al.,4 the tip of an endotracheal tube sometimes cannot be inserted into the trachea of certain patients even when the larynx is visualized on the GlideScope screen.
It is likely that both the AWS and GlideScope Ranger can contribute to prehospital care of patients in whom the trachea is difficult to intubate, but it is also obvious that conventional laryngoscopes should remain available.
Ryu Komatsu, MD
Kotoe Kamata, MD
Daniel I. Sessler, MD
Makoto Ozaki, MD
Departments of General Anesthesiology and
Department of Anesthesia
Department of Anesthesiology
Tokyo Women's Medical University
1. Xue FS, Yuan YJ, Wang Q, Xiong J. The Airway Scope may be less effective for tracheal intubation under direct daylight in a prehospital environment. Anesth Analg 2011;112:249
2. Nao Y, Kato T, Kusunoki S, Kawamoto M, Yuge O. [Use of AirWay Scope for tracheal intubation in bright sunlight.] Masui 2007;56:1408–10
3. Komatsu R, Kamata K, Sessler DI, Ozaki M. Airway Scope and Macintosh laryngoscope for tracheal intubation in patients lying on the ground. Anesth Analg 2010;110:427–31
4. Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth 2005;52:191–8