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Canadian Journal of Anesthesia 52:780-781 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

REPLY

Joseph Brimacombe, FRCA MD* and Shinichi Kihara, MD{dagger}

* James Cook University, Cairns, Australia
{dagger} University of Tsukuba, Tsukuba City, Japan, E-mail: jbrimaco{at}bigpond.net.au

We thank Dr. Stasiuk for expressing his specific concerns about our paper and his general concerns about the state of play of evidence-based airway management research and practice. We will mostly confine our response to the former, as we concur with much of the latter, albeit in a less emotive fashion.

First, although there are perhaps a dozen or so variations on using a stylet (there are certainly not as many variations as there are anesthesiologists!), we considered that ours was a reasonable simulation of what happens during difficult laryngoscope-guided tracheal intubation. Second, the "unacceptably high failure rate" (in fact only 13%!) when using the conventional stylet in simulated Cormack and Lehane grade 3 patients was due to resistance at the level of the glottic inlet. Third, we did not attempt to use the conventional stylet in simulated grade 4 patients, as we knew this had a very low success rate, and we felt it was unfair to subject our patients to near-certain airway management failure. Should we have included this subgroup, the differences between the StyletScopeTM and conventional stylet would probably have been much greater.

Finally, we disagree that the stylet is "almost always recommended as the first line of defense during problem intubations". Higher on the recommended list would be the tracheal tube guide or gum elastic bougie. Another increasingly recommended option would be to use the intubating laryngeal mask airway, which has a considerable body of evidence supporting its use during both simple and difficult laryngoscopies.1

Reference

1 Brimacombe J. Intubating LMA for airway intubation. In: Brimacombe J (Ed.). Laryngeal Mask Anesthesia. Principles and Practice. London: W.B. Saunders; 2004: 505–38.


Related articles in CJA:

"Conventional stylet" intubation - a misunderstood and misused concept
Russell B.P. Stasiuk
CJA 2005 52: 780. [Full Text]  




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