| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Correspondence |
1 West Midlands, UK
2 Essex, UK
To the Editor:
We read the review article by Kovacs et al.1 and Labrecque’s accompanying editorial2 with great interest. Like Dr. Labrecque, we are apprehensive about non-anesthesiologists performing the most hazardous tracheal intubations in the hospital. However, here in the UK, as throughout the rest of the world, this change will be inevitable.3
Rose’s study found a 0.3% incidence of failed intubations,4 which can be considered anatomically difficult. However, by the very nature of the indication for tracheal intubation, virtually all intubations in the emergency room are physiologically difficult. We believe that to successfully intubate the trachea with the minimum of physiological disturbance requires not only competency at direct laryngoscopy, but also an intimate knowledge of the whole armamentarium of anesthetic drugs at our disposal. Even the judicious use of sedative doses of anesthetic agents as alluded to by Labrecque cannot be learnt on an ad hoc basis. There is simply no substitute for familiarity with drugs which have such potentially devastating cardiorespiratory consequences in those with depleted physiological reserves.
Successful tracheal intubation is more than just passing an endotracheal tube through the vocal cords. Equally important in the emergency patient is to achieve this goal with the minimum of alteration to the patient’s physiological status. Such is the variation in both the patient’s underlying condition and his airway that a wide variety of approaches, including awake intubation and rapid sequence intubation may be appropriate. We believe that selecting the correct technique is part of the "art" of anesthesia, which could never be replicated by a physician who is not in regular anesthetic practice.
References
1 Kovacs G, Law JA, Ross J, et al. Acute airway management in the emergency department by non-anesthesiologists. Can J Anesth 2004; 51: 174–80.
2 Labrecque P. Tracheal intubation outside of the operating room (Editorial). Can J Anesth 2004; 51: 106–10.
3 Lockey DJ, Black JJ. Emergency physicians: additional providers of emergency anaesthesia? (Editorial). Anaesthesia 2002; 57: 629–31.[Medline]
4 Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994; 41: 372–83.
Related articles in CJA:
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
