A reply

Abstract

Listen

Translate article

We would like to thank Drs Maloney and Walker for bringing to our attention the series published by the Galway group comparing the Macintosh and the Airtraq laryngoscopes [1-5]. First impressions would appear to confirm these are indeed manikin studies that are followed by patient studies. However, a more detailed look at the study designs reveals a different picture. The three published manikin studies [1-3] compared the two devices in the hands of 40 medical students, then again 20 medical students and then 25 anaesthetists, all with no previous experience of using the Airtraq. The conclusion from the manikin studies was that the Airtraq was a superior device in the hands of novice personnel, infrequent users and anaesthetists with no prior experience. Interestingly, in their patient series comparing the two devices in patients with normal airways [6], cervical spine immobilisation [7] and features suggestive of difficult airways [8], all the intubations were performed by one of four anaesthetists experienced in the use of both laryngoscopes. The patient studies could have been and perhaps should have been performed without the three prior manikin studies, as the design and results have no bearing on each other. We wonder, had the results of the manikin study suggested that the Airtraq was inferior to the Macintosh, if the authors would have then decided not to proceed with the patient phase of their study? To further the argument one has to only look at manikin studies that compare the Macintosh laryngoscope with a newer device [1-3, 7-18]; the Macintosh laryngoscope always fared worse. What then does this say of manikins and of this device, which has been in use since 1941 and until today, is the most frequently used instrument during tracheal intubation? Whilst we do agree that a better manikin would certainly aid progress in training, it is not the appropriate research subject for the evaluation of airway equipment [19]. And to quote Ralph Waldo Emerson again: “I hate quotations. Tell me what you know.” No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.