The purpose of our study was to determine the feasibility of tracheal intubation with a VivaSight Single Lumen™ (SL; ETView Ltd, Misgav, Israel) through the Fastrach Laryngeal Mask Airway (FT-LMA; LMA North America, Inc., San Diego, CA) including the laryngeal view obtained when combining these devices as well as the success rate for tracheal intubation.1 Blind tracheal intubation through the FT-LMA has been criticized because of the potential risk of soft tissue trauma. As we mentioned in our study, one of the limitations was reporting our results in only patients with normal airways. However, because of ethical considerations, we believe that it is imperative to first study the feasibility of a novel technique in patients with normal airways. As an example, C-Trach LMA was first studied in patients with normal airways.2
We do not agree with Koopman et al.3 that inserting the endotracheal tube with a concave orientation through the FT-LMA has any influence on the intubation success rate. What really matters is to obtain a clear unobstructed view of the vocal cords, regardless of how they are oriented.
As also mentioned in our article, if a grade 2 or greater view was initially obtained, optimal alignment of the FT-LMA ventilation aperture with the glottis opening was obtained by performing adjusting maneuvers: up-down maneuver of the FT-LMA under vision, side-to-side maneuver, hyperextension of the head, or external manipulation of the larynx. These maneuvers allow for visual control of the anatomical structures during tracheal intubation and avoidance of potential tissue trauma by blind intubation.
Finally, no difficulties were encountered during passing the VivaSight-SL connector through the FT-LMA, as we used SL with a 4 Pin Stereo Jack connector (Fig. 1), which is different from the an SL with a 5 Pin Mini universal serial bus connector used by Koopman et al.3 According to the manufacturer, the connector was changed on November 8, 2009, and that might explain the difficulties Koopman at el.3 encountered in their study (Fig. 2).
Luis Gaitini, MD
Boris Yanovski, MD
Mostafa Somri, MD
Carin Hagberg, MD
Pedro Charco Mora, MD
Sonia Vaida, MD
Department of Anaesthesia
B’nai Zion Medical Center
1. Gaitini LA, Yanovski B, Mustafa S, Hagberg CA, Mora PC, Vaida SJ. A feasibility study using the VivaSight Single Lumen™ to intubate the trachea through the Fastrach Laryngeal Mask Airway: a preliminary report of 50 cases. Anesth Analg. 2013;116:604–8
2. Timmermann A, Russo S, Graf BM. Evaluation of the CTrach–an intubating LMA with integrated fibreoptic system. Br J Anaesth. 2006;96:516–21
3. Koopman EM, van den Berg B, Schauer A, Huitink J. Intubation with a VivaSight Single Lumen through a supraglottic airway device. Anesth Analg. 2013;117:748––9