CORRESPONDENCE
Nasotracheal Intubation and Advantages of Videolaryngoscopy To the Editor: We read with interest Lili et al’s1 study about the comparison of the Glidescope laryngoscope (GSL) and Macintosh laryngoscope for nasotracheal intubation in patients with ankylosing spondylitis. The authors discuss issues of clinical importance in their results, but in our opinion there are other topics that should be emphasized. The first and most important, nasotracheal intubation almost always requires an additional maneuver with the Magill forceps to address the tube towards the glottis, just like in the study by Lili and colleagues. This instrumentation is essential both with GSL and with Macintosh laryngoscope and makes the 2 devices ultimately comparable, which is not true for orotracheal intubation, during which GSL instrumentation is always greater than GSL indirect laryngoscopy.2 strumentation without proficiency3 is one cause for intubation failure and increased time of intubation. The study clearly demonstrates that if you add instrumentation with Magill forceps to accomplish Macintosh nasotracheal intubation, the performance of experienced operators is significantly poorer than with GSL in terms of success rate, duration, and Adnet and VAS scores. Secondly, the authors state in the discussion that the conventional airway assessment tests may not be reliable in predicting a difficult intubation in ankylosing spondylitis patients when using GLS. That is exactly what has been demonstrated in a previous study4 in which difficult airway predictors failed if applied to Macintosh laryngoscopy, but their accuracy significantly increased if applied to GSL and combined in the El-Ganzouri score (EGRI). The authors have no funding or conflicts of interest to disclose.
J Neurosurg Anesthesiol
Indeed, considering the 8 failed intubations (6 in the Macintosh group and 2 in the GLS group, which all demonstrated Mallampati IV; TM < 6.5 cm in spite an interincisor gap >4 cm; and an extreme limitation in atlanto-occipital extension), if the EGRI had been applied, the score would have been at least 6 (Mallampati IV = 2 points; limited head extension
Nasotracheal Intubation and Advantages of Videolaryngoscopy To the Editor: We read with interest Lili et al’s1 study about the comparison of the Glidescope laryngoscope (GSL) and Macintosh laryngoscope for nasotracheal intubation in patients with ankylosing spondylitis. The authors discuss issues of clinical importance in their results, but in our opinion there are other topics that should be emphasized. The first and most important, nasotracheal intubation almost always requires an additional maneuver with the Magill forceps to address the tube towards the glottis, just like in the study by Lili and colleagues. This instrumentation is essential both with GSL and with Macintosh laryngoscope and makes the 2 devices ultimately comparable, which is not true for orotracheal intubation, during which GSL instrumentation is always greater than GSL indirect laryngoscopy.2 strumentation without proficiency3 is one cause for intubation failure and increased time of intubation. The study clearly demonstrates that if you add instrumentation with Magill forceps to accomplish Macintosh nasotracheal intubation, the performance of experienced operators is significantly poorer than with GSL in terms of success rate, duration, and Adnet and VAS scores. Secondly, the authors state in the discussion that the conventional airway assessment tests may not be reliable in predicting a difficult intubation in ankylosing spondylitis patients when using GLS. That is exactly what has been demonstrated in a previous study4 in which difficult airway predictors failed if applied to Macintosh laryngoscopy, but their accuracy significantly increased if applied to GSL and combined in the El-Ganzouri score (EGRI). The authors have no funding or conflicts of interest to disclose.
J Neurosurg Anesthesiol
Indeed, considering the 8 failed intubations (6 in the Macintosh group and 2 in the GLS group, which all demonstrated Mallampati IV; TM < 6.5 cm in spite an interincisor gap >4 cm; and an extreme limitation in atlanto-occipital extension), if the EGRI had been applied, the score would have been at least 6 (Mallampati IV = 2 points; limited head extension
