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In reply: Not which forceps, but whether forceps?

  • Jong H. Yeom
  • Mi K. Oh
  • Woo J. Shin
  • Dae W. Ahn
  • Woo J. Jeon
  • Sang Y. Cho
In reply
  • 343 Downloads

To the Editor,

We appreciate the keen interest and thoughtful comments by Dr. Turkstra1 on our study2 where we found that using a forceps-guided tube exchanger could be advantageous when using the GlideScope® videolaryngoscope (GVL; Verathon Medical Inc., Bothell, WA, USA) for oral endotracheal tube (ETT) intubation. The reason for an advantage might be the flexibility and pliability of a tube exchanger. Another study of nasotracheal intubation by Lim et al.3 showed that the pliable and flexible nasogastric tube passed preferentially through the lower aspect of the nasal passage with a preformed ETT easily advancing towards the laryngeal inlet. We hypothesized that the flexibility and pliability of a tube exchanger would be effective for nasotracheal intubation using a GVL.4 To apply the same conditions for the two groups, forceps were used in all patients because insertion and removal of the forceps consumed some time.

We performed hundreds of nasal intubations in another study two decades ago5 and are also familiar with a GVL.2 Before study implementation, three operators were trained in nasal intubation using a GVL. As mentioned above, the two different forceps were used in both groups. In the study2 commented on by Dr. Tursktra, the incidence of sore throat was not significantly different between the different groups. Admittedly, a weakness of this study, which compared two different types of forceps, was that the participating anesthesiologists were not blinded to the assigned groups; this could have introduced some bias.

Lastly, Dr. Turkstra cautions against the study’s technique2 of inserting a nasal ETT prior to verifying a good videolaryngoscopic view. We agree with this caution as epistaxis is the most common complication following nasotracheal intubation. Many methods have been used to reduce the incidence and severity of bleeding.3-5 In many studies using a GVL,2,5 glottic exposure was significantly better with the GVL. In this study, only two study subjects had a grade III glottic view, and there were no significant differences between the groups.

In conclusion, using a tube exchanger and vascular forceps offers advantages over the use of Magill forceps and over a GVL for nasotracheal intubation.

Notes

Conflicts of interest

None declared.

Editorial Responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

References

  1. 1.
    Turkstra TP. Not which forceps, but whether forceps? Can J Anesth 2018. DOI:  https://doi.org/10.1007/s12630-018-1114-2.Google Scholar
  2. 2.
    Yeom JH, Oh MK, Shin WJ, Ahn DW, Jeon WJ, Cho SY. Randomized comparison of the effectiveness of nasal intubation using a GlideScope with Magill forceps versus vascular forceps in patients with a normal airway. Can J Anesth 2017; 64: 1176-81.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lim CW, Min SW, Kim CS, Chang JE, Park JE, Hwang JY. The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial. Anaesthesia 2014; 69: 591-7.CrossRefPubMedGoogle Scholar
  4. 4.
    Kim YC, Lee SH, Noh GJ, et al. Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage. Anesth Analg 2000; 91: 698-701.CrossRefPubMedGoogle Scholar
  5. 5.
    Jones PM, Armstrong KP, Armstrong PM, et al. A comparison of GlideScope videolaryngoscopy to direct laryngoscopy for nasotracheal intubation. Anesth Analg 2008; 107: 144-8.CrossRefPubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  • Jong H. Yeom
    • 1
  • Mi K. Oh
    • 1
  • Woo J. Shin
    • 1
  • Dae W. Ahn
    • 1
  • Woo J. Jeon
    • 1
  • Sang Y. Cho
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineHanyang University Guri HospitalGuri-siRepublic of Korea

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