Year: 2007
Type: article
Abstract: We thank Drs Cook and Wharton for their interest in our paper, but they seem to have missed the point of our study. Our purpose was to study the effectiveness of counter-clockwise rotation of the tube in overcoming impingement when encountered in the presence of cricoid pressure. As we described this manoeuvre failed to relieve impingement for an obstetric patient in our hospital and led to a ‘failed intubation’ scenario. We believe that cricoid pressure was the cause of this failure, and our results support this view. We do not know of any information about what size of tube is used routinely for tracheal intubation in the UK. Perhaps Drs Cook and Wharton, at the risk of disheartening themselves further, may like to find this out. We believe most anaesthetists use 8-mm and 9-mm tracheal tubes for routine cases and suspect that when difficulty is encountered they persist with it. Our study would have been meaningless if we had used different tracheal tubes from those used in routine practice. We accept that the use of a smaller tube may make impingement less of a problem. This is supported by the literature quoted, although none of these studies involved the use of cricoid pressure. We believe that, whatever size of tube is used, cricoid pressure should be released if counter-clockwise rotation of the tube fails to overcome the ‘impingement’.
Source: Anaesthesia
Authors: J. E. Duggan, U. McNelis
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4255149702