Lightwand-Assisted Intubation of Patients in the Lateral Decubitus Position

Abstract

In Response: Using lightwand-assisted intubation via the intubating laryngeal mask airway (ILMA) or lightwand-assisted intubation directly has been demonstrated to successfully establish patient airway patency under supine or lateral position (1,2). Dimitriou et al.'s (1) description of the technique of lightwand-assisted intubation via the ILMA did incorporate two separate aspects: the initial insertion of the ILMA apparatus, followed by the subsequent lightwand-guided intubation. Here, we are trying to use lightwand-assisted intubation directly, eliminating the procedure of insertion of the ILMA apparatus, and we were successful. In addition, there is no obvious difference of intubating-related data in comparison with ours. Lightwand-assisted intubation directly provides a rapid and safe technique to establish airway patency for patients lying in a number of different positions including the supine, left, or right lateral positions. In addition, it is not complicated for clinical personnel, whether they are residents or attending medical personnel. The intubating time was counted from the left hand opening the mouth, insertion of the assembly into trachea, removal of the wand from the tracheal tube following correct placement of the ETT, to connecting the respirator. Both the techniques of lightwand-assisted intubation directly or using lightwand-assisted intubation via the ILMA provide fast intubation in acceptable intubation time. I cannot determine if there are any advantages of saving 15 seconds in this study. In actuality, there are many things to do for resuscitation for these 15 seconds. There are some conflicting data on spontaneous or mechanical ventilation while patients are in supine position with LMA or ILMA (3–5). There is no adequate data to prove the benefit of ILMA or LMA while patients were ventilated under lateral position (6–8). However, it is true that I stated the results of ventilation via the ILMA and LMA from inexperienced personnel initially. Actually, I want to emphasize the problem of air leakage. Therefore, we discussed about the novice and attending investigator in the next paragraph. I cannot agree more with Dimitriou et al. when they stated “the ILMA may be better for airway rescue, as it allows ventilation before intubation.” However, we have to keep in mind that, while using ILMA or LMA, some patients still failed to establish patent airway in the lateral position (6–7). Under such a condition, the simple and easy method using a face mask to maintain airway patency should be used. Kuang-I Cheng, MD Koung-Shing Chu, MD Siu-Wah Chau, MD Chao-Shun Tang, MD *Department of Anesthesiology Kaohsiung Medical University Kaohsiung, Taiwan [email protected] †Department of Anesthesiology Kuo General Hospital Tainan, Taiwan Republic of China