Correspondence  |   December 2016
In Reply
Author Notes
  • Graduate School of Medicine, Chiba University, Chiba, Japan (S.I.).
  • (Accepted for publication August 17, 2016.)
    (Accepted for publication August 17, 2016.)×
Article Information
Correspondence   |   December 2016
In Reply
Anesthesiology 12 2016, Vol.125, 1249-1250. doi:10.1097/ALN.0000000000001374
Anesthesiology 12 2016, Vol.125, 1249-1250. doi:10.1097/ALN.0000000000001374
We thank you for your interest in reading the article by Ramsingh et al.1  and our accompanying editorial2  and appreciate the concerns raised in the letters that auscultation may not have been optimally performed, that the cost of using ultrasound to differentiate tracheal versus bronchial intubation might not have been properly appreciated (Dr. Levy), or that the editorial dismisses the stethoscope as a useless thing of the past (Dr. Jablons).
In their article, Ramsingh et al.1  stated: “Since auscultation for breath sounds is regarded as a basic skill, all attending anesthesiologists, with more than 4-yr posttraining, were allowed to perform the auscultation examination.” We assumed that auscultation would be optimally performed, but we also contacted Dr. Ramsingh and obtained more detailed information about their auscultation technique. Dr. Ramsingh responded: “Manual ventilation was initiated with target volumes of approximately 8 to 10 ml/kg ideal body weight, auscultation was performed bilaterally in each axilla at the mid-axillary line (approximately at the level of the fifth rib space).” This description of the auscultation technique represents a reasonable practice and may exceed the quality of true clinical practice. In this regard, we think that the comparison is reasonable: a new technique versus a routine clinical practice. In addition, there are several other studies demonstrating low sensitivity and specificity of auscultation for differentiating tracheal versus bronchial intubation, and the values Ramsingh et al.1  reported in their study are comparable with those reported by other investigators.3–5  Nevertheless, we do agree with you that the sensitivity and/or specificity of auscultation might improve if it was executed in combination with other clinical assessments as you suggested. However, the sensitivity and specificity of auscultation unlikely approach the sensitivity (93%) and specificity (96%) obtained with ultrasound alone.1 
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