Correspondence  |   July 2017
In Reply
Author Notes
  • Oregon Health and Science University, Portland, Oregon (M.F.A.). azizm@ohsu.edu
  • (Accepted for publication April 9, 2017.)
    (Accepted for publication April 9, 2017.)×
Article Information
Correspondence
Correspondence   |   July 2017
In Reply
Anesthesiology 7 2017, Vol.127, 202-203. doi:10.1097/ALN.0000000000001692
Anesthesiology 7 2017, Vol.127, 202-203. doi:10.1097/ALN.0000000000001692
We thank Drs. Xue et al., Drs. Herway and Benumof, and Drs. Maslow and Panaro for their interest and thoughtful comments regarding our recent publication.1  They offer several interesting insights and questions regarding our article that we wish to address.
All three letters point out that video laryngoscopy was not universally successful as a rescue technique and that other approaches to intubation and oxygenation should be considered. Furthermore, training and competency with other primary or rescue tools should be maintained. We absolutely agree. The practical application of our findings provides a framework for prioritizing how to best invest time and training in rescue techniques. The sugraglottic airway in particular offers advantages to maintain oxygenation and ventilation as a definitive airway or as a conduit for final tracheal intubation. Indeed, many patients in this data set were effectively temporized in this fashion. However, when used to guide tracheal intubation with or without the use of a flexible bronchoscope, the supraglottic airway was not as successful as video laryngoscopy. Nor was the flexible bronchoscope as successful. Does this mean that these well-established techniques should be abandoned? Certainly not! They have a clear role when video laryngoscopy is not feasible or when used by providers more experienced with these techniques. That said, if a higher risk of failure is anticipated or when preparing for an unanticipated difficult direct laryngoscopy, our data support the immediate availability of video laryngoscopy.
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