To the Editor:—
I read with great interest the case report by Dhonneur et al. 1using the Airtraq® (King Systems, Noblesville, IN) optical laryngoscope after failed direct laryngoscopy in two patients requiring emergency cesarean delivery. Placing an Airtraq® (or any of the new video-laryngoscopes, e.g. , GlideScope®[Verathon, Bothell, WA], McGrath®[LMA North America, San Diego, CA]) as a brief plan B after a failed direct laryngoscopy in obstetrics may be an evolving new standard of practice for an emergency cesarean delivery. However, comparing the Airtraq® intubation time with the LMA CTrach ™ (LMA North America, San Diego, CA) intubation time (<1 min vs. 3 min) is not an entirely appropriate comparison.1The CTrach time of 3 min includes establishing ventilation and removing the CTrach airway after intubation is confirmed.2The ventilatory capacity of the CTrach is arguably equally important to its effectiveness as an intubation conduit during airway resuscitation.3It is well known how quickly a term parturient can desaturate during laryngoscopy. The CTrach (like the intubating laryngeal mask airway) is an effective ventilatory device with ventilatory success rates of greater than 99%.2,4If intubation is not successful, the presence of an effective airway can be lifesaving. The CTrach gives the operator time to optimize the laryngeal view and the patient's physiologic parameters before attempting intubation.3,5Liu et al. 2report a 99% first-pass intubation success in the 84% of patients whose larynx was seen on the CTrach monitor. In the remaining 16%, the CTrach functioned as an intubating laryngeal mask airway would, with corresponding intubation/ventilation success rates. Ventilation and oxygenation, not solely intubation, are the primary goals of effective airway resuscitation.
University of Washington, Seattle, Washington. firstname.lastname@example.org