This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Miller, L. Search for Related Content PubMed PubMed Citation Articles by Miller, L.

To the Editor:

Salisbury, England

I read with interest the recent article by Arino et al.,¹ assessing the use of straight blades (Miller, Belscope) or curved blades (Macintosh, McCoy, Lee-Fiberview) in the improvement of visualization of the larynx and ease of intubation.

It was noted in the conclusion that straight blades give the best visualization of the larynx. However, "the function of laryngoscopy is ease of placement of the endotracheal tube and a curved blade was optimal in this respect".¹

In the United Kingdom, in situations of difficult intubation a gum elastic bougie is traditionally used² and has reported success rates of 96%.³ In this case visualization of the larynx to aid placement of the bougie is the most important factor. The increased space in the oropharynx to maneuver the endotracheal tube (as provided by a curved blade) is therefore not required, as studies show that once the bougie has been placed the tube can always be railroaded into position.⁴ Hames et al. recently suggested greater success with fibrescopes but at present in the UK these are not readily available and require dual operators at a time of urgency.³

It may be suggested that in the management of patients with difficult intubation the use of a straight blade with a gum elastic bougie is an alternative strategy in the accurate placement of the endotracheal tube.

References

1 Arino JJ, Velasco JM, Gasco C, Lopez-Timoneda F. Straight blades improve visualization of the larynx while curved blades increase ease of intubation: a comparison of the Macintosh, Miller, McCoy, Belscope and Lee-Fiberview blades. Can J Anesth 2003; 50: 501–6.[Abstract/Free Full Text]

2 Latto IP, Stacey M, Mecklenburgh J, Vaughan RS. Survey of the use of the gum elastic bougie in clinical practice. Anaesthesia 2002; 57: 379–84.[Medline]

3 Hames KC, Pandit JJ, Marfin AG, Popat MT, Yentis SM. Use of the bougie in simulated difficult intubation. 1. Comparison of the single-use bougie with the fibrescope. Anaesthesia 2003; 58: 846–51.[Medline]

4 Gataure PS, Vaughan RS, Latto IP. Simulated difficult intubation. Comparison of the gum bougie and the stylet. Anaesthesia 1996; 50: 935–8.

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Miller, L. Search for Related Content PubMed PubMed Citation Articles by Miller, L.