Forceps dilatational percutaneous tracheostomy: safe and short.We read with interest the article published by Dr Kaiser and colleagues (1) on the comparison of progressive dilatational vs forceps dilatational percutaneous tracheostomy.
We would like to contribute to the discussion reporting our prospective, unrandomized series of percutaneous tracheostomy for long-term ventilation. Our preferred technique is the Griggs technique performed in combination with a LMA LMA left mentoanterior (position of fetus). for airway control (2).
To date we have successfully performed more than 290 percutaneous tracheostomies with dilating forceps. No instances of post tracheostomy tracheal dilatation (3) have been recorded.
We agree that the Guide Wire Dilating Forceps technique is safe and easy to learn, and quicker than the consecutive/progressive dilatator technique. We believe that continuous fibreoptic monitoring is mandatory to ensure correct access and to minimize complications.
In a few cases the forceps could not be inserted to the full length due to thick subcutaneous tissue of the anterior neck. In such cases we suggest switching the percutaneous tracheostomy from forceps to progressive dilatator, allowing completion of the procedure without complications.
In our experience the removal of the endotracheal tube and substitution with a classic LMA results in a better view of the entire laryngeal inlet. The possibility of using a Pro Seal LMA instead of a classic LMA should be considered (4), especially for obese patients and those with high peak pressures.
(1.) Kaiser E, Cantais E, Goutorbe P et al. Prospective randomized comparison of progressive dilatational vs forceps dilatational percutaneous tracheostomy. Anaesth Intensive Care 2006; 34:51-54.
(2.) Cattano D, Buzzigoli S, Zoppi C et al. "The use of the Laryngeal Mask Airway Invention and development
The first laryngeal mask airway, the LMATM airway, was invented in the 1980s by the British anaesthetist, Dr. Archie Brain. Since their introduction twenty plus years ago as a safe, effective alternative to the endotracheal tube doctors and during Guide wire dilatating forceps tracheostomy" IARS IARS International Anesthesia Research Society
IARS Integrated Airborne Reconnaissance Strategy
IARS Image Archive & Retrieval System
IARS Improved Aerial Refueling System 80th congress, 24th-28th March San Francisco, USA Anesth Analg 2006; 102-2S:86.
(3.) Steele APH, Evans HW, Afaq MA et al. Long term follow up of Griggs tracheostomy with Spiral CT and questionnaire. Chest 2000; 117:1430-1433.
(4.) Craven RM, Laver SR, Cook TM et al. Use of the Pro Seal LMA facilitates percutaneous dilatational tracheostomy. Can J Anesth 2003; 50:718-720.
Department of Anesthesiology,
Washington University of St Louis, School of
St Louis, United States
Department of Surgery, University of Pisa The University of Pisa (Italian Università di Pisa) is one of the most renowned Italian universities. It is located in Pisa, Tuscany. It was formally founded on the September 3, 1343 by an edict of Pope Clement VI, although there had been lectures on law in Pisa since the ,
Department of Surgery,
University of Pisa School of Medicine,
Anesthesiology and ICU ICU intensive care unit.
intensive care unit
see intensive care unit.
Versilia Hospital, Lido di Camaiore (Lu), Italy