Comments on published article.

Dear Sir,

We read with interest the communication from Dr. Sahay et al. published in the November issue of Indian Journal of Anaesthesia.[1] The authors describe the use of the i-gel®, trimmed to size, to serve as a bite block and for centralization of the fiberscope during awake fiberoptic intubation in adults. They also mention the use of the drain port to insufflate oxygen during the procedure.

Although this is a useful hack to prevent biting of the scope while centralizing it in the oral cavity, it will do little to prevent the soft tissues of the upper airway from collapsing around and impeding fiberscope advancement. Not surprising then, that the authors mention need for jaw thrust in many of their patients. Also, a high-flow nasal oxygen delivery system may be a superior alternative to improve oxygenation, reduce the risk of desaturation, and optimize conditions for awake fiberoptic intubation.[2]

While awake intubation is an option in adults, infants and children with difficult airways will almost always need general anesthesia for securing the airway. In truly difficult airways, supraglottic airways can be placed with topicalization of the oral mucosa.[3] Continuous ventilation through the supraglottic airway lowers the incidence of hypoxemia, and inhalational anaesthetic induction can be carried out. In infants with difficult airways, fibreoptic intubation via a supraglottic airway has been associated with higher first attempt success rates than video laryngoscopy.[4]

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