Paediatric Airtraq for adult nasal intubation in anaesthetized patients.

also had to take another factor into consideration— pulmonary aspiration. Airway reflexes are necessary to minimize aspiration, and to expel out aspirated materials from the airway, if aspirated. Therefore, while inhibition of the airway reflexes (by topical anaesthesia, sedation, or both) would reduce the stress to awake patients, it also increases the risk of aspiration. All three patients reported 1 were at high risk of aspiration, and thus I applied topical anaesthesia only to the nasal cavities. When it is unsuitable to give topical anaesthesia to the airway or unsuitable to give sedatives (like in these cases), one should find the least stressful and reliable method to achieve tracheal intubation. Insertion of the Airway Scope does not require extension of the head and does not distort the anatomical structures as much as the Macintosh laryn-goscope does, and thus insertion should be less stressful. All three patients tolerated insertion of the Airway Scope and no marked straining was observed. The Eschmann's tube exchange catheter (gum elastic bougie) is designed to insert into the trachea by adjusting direction of its angulated tip. Therefore, the claim that inappropriate bending of the distal portion is unfavourable for insertion into the trachea is unwarranted. As Dr Xue and colleagues point out, a fibreoptic bronchoscope may be used to guide the tube into the trachea. I did not use this, because at least two anaesthetists would be required. In contrast, the use of the bougie requires only one person, and is simpler. While a recent letter 9 states that the blade of the Airway Scope is frequently too short to reach the epiglottis, none of the major formal studies reports this problem. For example, in a study of 293 patients with predicted or known difficult tracheal intubation using the Macintosh lar-yngoscope, tracheal intubation using the Airway Scope was successful in 290 patients, and in none of the patients was it necessary to be aided by a fibreoptic bronchoscope, or did the blade of the Airway Scope fail to reach the epi-glottis. 11 At an early stage of using the Airway Scope, I experienced difficulty in reaching the blade tip to the epi-glottis when the patient's head and neck were placed to the sniffing position. The shape of the Airway Scope blade is designed based on the curve of the oropharyngeal cavity, with the head and neck in the neutral position. Therefore, it may be that the …