To the Editor
The results of the recent study by Gaitini et al.1 describing a nearly 100% success rate for a novel intubation technique with a VivaSight Single Lumen™ (SL; ETView Ltd, Misgav, Israel) tube and a Fastrach Laryngeal Mask Airway™ (FT-LMA; LMA North America, Inc., San Diego, CA), while impressive, was limited by the fact that, as admitted by the authors, only patients with normal airways were studied. We recently described a similar intubation method2 and believe that compared with other supraglottic airway devices (SADs) there are several drawbacks in using the FT-LMA.
First, in contrast to other SADs, the rigid FT-LMA has a very sharp curve. To narrow the angle with which the VivaSight-SL exits the FT-LMA and hence to improve intubation success rate, the reversed curve technique, as previously described by Ye et al.,3 should be applied. Therefore, images are displayed upside down on the monitor. This obviously can impede anatomic orientation, which seems particularly undesirable in situations where conventional airway management has already failed.
Second, the FT-LMA’s epiglottic elevating bar blocks the view on the glottis when the VivaSight-SL is advanced through it. Because of the epiglottic elevating bar, fiberoptic views through the FT-LMA are considered poorer compared with views through other SADs.4
Finally, we wonder whether the authors didn’t encounter any problems passing the VivaSight-SL’s mini universal serial bus connector through the FT-LMA. In a pilot study comparing different SADs as intubation conduits for the VivaSight-SL, we found this connector hardly fitted the FT-LMA’s internal diameter (Fig. 1, A and B). Occasionally we had to cut the video cable to remove the FT-LMA once the airway was secured.
Erik Michiel Koopman, MD
Bastiaan van den Berg, MD
Axel Schauer, MD, Dr Med
Johannes Huitink, MD, PhD
Department of Anesthesiology
VU University Medical Center
Amsterdam, The Netherlands
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. Huitink JM, Koopman EM, Bouwman RA, Craenen A, Verwoert M, Krage R, Visser IE, Erwteman M, van Groeningen D, Tijink R, Schauer A. Tracheal intubation with a camera embedded in the tube tip (Vivasight(™)). Anaesthesia. 2013;68:74–8
3. Ye L, Liu J, Wong DT, Zhu T. Effects of tracheal tube orientation on the success of intubation through an intubating laryngeal mask airway: study in Mallampati class 3 or 4 patients. Br J Anaesth. 2009;102:269–72
4. McNeillis NJ, Timberlake C, Avidan MS, Sarang K, Choyce A, Radcliffe JJ. Fibreoptic views through the laryngeal mask and the intubating laryngeal mask. Eur J Anaesthesiol. 2001;18:471–5