The Airway Scope Is a Practical Intubation Device For a Double-Lumen Tube During Rapid-Sequence Induction

LETTERS TO THE EDITOR

The Airway Scope Is a Practical Intubation Device For a Double-Lumen Tube During Rapid-Sequence Induction To the Editor: In emergency surgery, anesthesiologists use a “rapid-sequence induction,” which requires technical expertise and a reliable intubation device to minimize the risk of difficult intubation. Furthermore, when cricoid pressure is applied by an assistant, this maneuver may interrupt visualization of the larynx.1 During rapid-sequence induction, intubation with a double-lumen tube is sometimes difficult because of limited glottic viewing. The Airway Scope (AWS) (AWS-S100; Pentax, Tokyo, Japan) is a rigid video laryngoscope used for tracheal intubation.2 The built-in monitor screen has a wide viewing angle of the larynx including the glottis and inlet portion of the esophagus. These features allow the anesthesiologist to achieve reliable intubation during the Sellick maneuver. Herein, we describe the use of the AWS for rapid-sequence induction and insertion of a double-lumen tube without distortion of the glottis. A 75-year-old man weighing 60 kg was brought for emergency surgery because of a hemothorax. He was preoxygenated with a face mask. Rapid-sequence induction of anesthesia was performed with thiopental and succinylcholine. To obtain wide glottic viewing, the AWS is superior to laryngoscopy with a Macintosh 3 blade; it was chosen for the intubation with a double-lumen tube. While maintaining cricoid pressure, a double-lumen tube (35F) was easily inserted. The AWS provided a Cormack grade 1 view during the Sellick maneuver. As an intubation scope for inserting a double-lumen tube, the AWS features a wide viewing angle and obtains excellent anatomic orientation including the glottis and inlet to the esophagus. Therefore, the AWS-aided double-lumen tube intubation may be a safe and useful method during rapid-sequence induction. Toji Yamazaki, MD, PhD Hisatoshi Ohsumi, MD, PhD Department of Anesthesiology National Hospital Organization Kinki-chuo Chest Medical Center Osaka, Japan REFERENCES 1. Smith CE, Boyer D: Cricoid pressure decreases ease of tracheal intubation using fibreoptic laryngoscopy (WuScope System). Can J Anaesth 49:614-619, 2002 2. Suzuki A, Toyama Y, Katsumi N, et al: The Pentax-AWS rigid indirect video-laryngoscope: Clinical assessment of performance in 320 cases. Anesthesia 63:641-647, 2008 doi:10.1053/j.jvca.2008.12.015

Fatal Necrotic Pancreatitis as a Rare Complication After Thoracoabdominal Aortic Surgery To the Editor: Surgical repair of the thoracoabdominal aorta is associated with significant perioperative mortality (up to 10.3%) and morbidity.1-3 Major postoperative complications are pulmonary dysfunction (49%), acute renal failure (20.9%), spinal cord ischemia (up to 20.3%), and cardiac complications (14.7%).1 Gastrointestinal complications (1.8%) are rarely found1 and are mainly characterized by bowel ischemia or ileus.4 We report a case of a 69-year-old female patient with fatal necrotic pancreatitis after thoracoabdominal aortic repair. She presented for surgical repair of a post–type B dissection thoracoabdominal aneurysm type III (modified Crawford classification) with a diameter of 56 mm extending from T9 to the iliac arteries. Except for the right renal artery, all visceral arteries originated from the true lumen of the dissected aorta. Comorbidities consisted of arterial hypertension, osteoporosis, urolithiasis, and gastric vagotomy 20 years ago. History, a preoperative computed tomography (CT) scan, and laboratory investigations were not indicative for pre-existing pancreatic disease. 926

Journal of Cardiothoracic and Vascular Anesthesia, Vol 23, No 6 (December), 2009: pp 926-938