ANESTHETIC COMMENTARY I applaud the attempt of Mark et al. to address the compli- simple conditions remains the intubation with the fiber- cated issue how to manage the difficult airway in Noma bronchoscope [10]. patients. Admittedly, this is not an easy task to find the Why should we put our elective patients through an un- safest and best way under these difficult conditions. But necessary risk? we must be well aware that we deal with elective proce- dures not with emergency situations. The points that I am attempting to convey are: References · The approach to open the mouth by cutting the trismus 1. Cases JI, Ferrandaz M (1991) Minitracheostomy in elective sur- can cause some hemorrhagic problems. gery of the larynx: an alternative to formal tracheostomy. Can J We can never be sure that it doesn't bleed into the mouth Anaesth 38:761±763 and down the trachea. Aspiration is possible, because the 2. Benumof JL, Scheller MS (1989) The importance of transtrache- mini-tracheostomy tube has no cuff. In one report about al Jet ventilation in the management of the difficult airway. An- esthesiology 71:769±778 the use of minitracheostomy in elective surgery one con- 3. Jacoby JJ, Harmelbury W (1956) Transtracheal resuscitation. dition was considered to be essential: The surgical proce- JAMA 162:625 dure should be non-hemorrhagic [1]. 4. Ravussin P, Freeman J (1985) A new transtracheal catheter for · It is very difficult to manually ventilate the lungs of ventilation and resuscitation. Can J Anaesth 32:60±64 adult patients by using the conventional anesthesia bag 5. Sugiura N, Miyake T (1992) The use of a nasogastric tube as an aid in blind nasal nasotracheal intubation. Anesthesiology or a self inflating bag through a small tube [2]. 77:613±614 · We clearly lack good information about the rise of pCo2 6. Sugiura N (1997) Letter. Anesthesiology 87:449 in manually ventilated patients through a small tube. The 7. Gorbach MS (1987) Inflation of endotracheal tube cuff as an aid manual ventilation through a small transtracheal tube was to blind nasal endotracheal intubation. Anesthesia Analg 66:913±922 primarily designed for the emergency treatment of the 8. Benumof JL (1991) Management of the difficult airway with hypoxic, difficult to intubate patient [3, 4]. special emphasis on awake tracheal intubation. Anesthesiology · Why do the authors make only 2 attempts AT blind na- 75:1087±1110 sal intubation? There are several good, easy and success- 9. Spencer CD, Beatty HN (1972) Complications of transtracheal aspiration. N Engl J Med 286:304±305 ful techniques of blind nasal intubation [5±8]. 10. Tassonyi E, Lehmann C, Montandon D (1990) Fiberoptically · The method of cricithyroid aspiration is not without oth- guided intubation in children with gangrenous stomatitis. Anes- er risks. Life threatening complications can occur [9]. thesiology 73:348±349 How should we treat these complications in poorly equi- ped hospitals of developing countries? P. Schüller DEAA In my opinion the method of choice for difficult intubat- Kreiskliniken ions of elective Noma children and adults under these D-83362 Traunstein, Germany European Journal of Plastic Surgery Springer Journals


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Copyright © 1998 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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