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Article first published online: 14 MAR 2011
Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland
Volume 66, Issue 4, page 315, April 2011
How to Cite
Hodzovic, I. and Lewis, A. R. (2011), A reply. Anaesthesia, 66: 315. doi: 10.1111/j.1365-2044.2011.06666.x
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- Issue published online: 14 MAR 2011
- Article first published online: 14 MAR 2011
We would like to thank Dr Kessell and his colleagues for their interest in our study. They conclude that videolaryngoscopes ‘may not prove so promising’ in the pre-hospital environment, due to the degradation of the image by secretions and the videolaryngoscope preparation time.
Secretions, vomit or blood are supposed to be cleared as part of the preparation for intubation irrespective of the type of laryngoscope used. There were no failed intubations in Helm study due to the presence of secretions, blood or vomit. In this study, suction was used in 62% of patients that required ‘measures to assist’ tracheal intubation. Although secretions may be the most common cause for difficulties during pre-hospital intubation, they are relatively easy to deal with. Consequently, the presence of secretions or blood in the airway is quite likely to be less of a problem when compared with the intubation difficulties caused by patient’s position or anatomical reasons (aspects of intubation difficulty simulated in our study).
Furthermore, there is no evidence to support the suggestion that secretions make intubation significantly more difficult with the Airway Scope than with the Macintosh blade. This seems to be extrapolated from the use of fibreoptic ‘scopes, which have a narrower field of view, and are not designed to create a space within the airway during use. In contrast, the use of videolaryngoscope is associated with the creation of a space within the airway, a manoeuvre that is likely to keep the camera eye well away from the secretions.
We disagree that the timing of the intubation in our study should have included preparation of the device. Paramedics are trained to pre-oxygenate effectively (at least 30 s) and check and prepare their equipment before intubation attempts. Although paramedic crews may have different procedures for preparing for intubation, checking and preparing the equipment are done before an intubation attempt; this is the reason why we provided the information on the time taken to mount the tube onto the videolaryngoscope as a separate outcome.
We believe the evidence provided in our study fully supports the conclusion of the study, which states that ‘the Airway Scope and Airtraq have significant advantages over the Macintosh laryngoscope’ and that of the two, the Airway Scope is the more effective device to use in the prehospital environment.
The equipment for our study was provided by Prodol Ltd and Pentax Ltd. No other external funding or competing interest declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.