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Canadian Journal of Anesthesia 54:242-243 (2007)
© Canadian Anesthesiologists' Society, 2007

Correspondence

REPLY

Grainne Nicholson, MB BS and George Hall, PhD

St George’s Hospital Medical School, London, UK, E-mail: gnichols{at}sgul.ac.uk

Thank you for the opportunity of replying to the letter of Dr. Kapoor and colleagues.

Dr. Kapoor and colleagues comment that we have reviewed a limited number of airway management techniques in patients with angiotensin converting enzyme inhibitors (ACEI) related angioedema and suggest that early pre-emptive cannula cricothyroidotomy may be useful. This is based on their own experience of three patients in three years.1 It would be helpful if Dr. Kapoor and colleagues included some clinical details about their patients including presenting signs and symptoms as well as rapidity of diagnosis.

The purpose of our review was not to discuss emergency airway management techniques, but to increase awareness amongst clinicians of the risk of angioedema in patients on ACEI drugs. We again emphasize that initial diagnosis of the condition is most important. Securing the airway is the mainstay of successful management and this may indeed require a tracheostomy. Cannula cricothyroidotomy is a well recognized useful technique in the short term, but is not an effective substitute for securing a definitive airway.

Reference

1 Gerig HJ, Schnider T, Heidegger T. Prophylactic percutaneous transtracheal catheterisation in the management of patients with anticipated difficult airways: a case series. Anaesthesia 2005; 60: 801–5.[Medline]


Related articles in CJA:

Airway management in angiotensin converting enzyme inhibitor related angioedema
Avinash Kapoor, Paul Jefferson, and David R. Ball
CJA 2007 54: 242. [Full Text]  




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