In Reply:—

I am grateful to Dr. Livingston, Dr. Durell, and Dr. Bourke for their relevant comments and references. Dr. Livingston and Dr. Durell are correct in suggesting that their previously described 1“epiglottic elevator” for difficult intubations has features similar to my technique using the LTA® cannula (LTA® 360 Kit, Abbott Laboratories, North Chicago, IL). However, the LTA® cannula dispenses topical anesthesia, which is useful in its own right. Also, I believe that by naming their device an “epiglottic elevator,” they underestimate the benefit of the anatomic distortion of the glottis that may occur when their device is positioned in the trachea.

Dr. Bourke's remarks are also cogent. His reference 2refers to the technique of passing the LTA® cannula through the Murphy eye of the endotracheal tube, placing the LTA® cannula into the trachea, and then sliding the tube over the LTA® cannula into the trachea. This technique requires loading the endotracheal tube on the LTA® cannula before insertion of the cannula into the trachea. Perhaps Dr. Bourke is also suggesting that the LTA® cannula can be passed into the trachea without first loading the endotracheal tube. The LTA® syringe could be removed from the cannula, and the cannula could be threaded through the Murphy eye “as a stylet guide over which the endotracheal tube is advanced into the trachea.” This modification sounds possible; however, I have neither tried it myself nor seen it reported. In any case, I believe that these previous techniques, although relevant and useful, will result in no greater success than the placement of the endotracheal tube beside the LTA® cannula as described in my letter to the editor.

Livingston M, Durell R: Epiglottic elevator. A nesthesiology 1967; 28: 214–5
Rosenberg MB, Levesque PR, Bourke DL: Use of the LTA kit as a guide to intubation. Anesth Analg 1977; 56: 287–8