Sphingosine kinase‐signaling pathway: a possible therapeutic target for post‐operative cognitive dysfunction

Sir, Andersen et al. demonstrated that tracheal intubation in obese patients could be equally achieved either by using a videolaryngoscope (VLS) or by direct laryngoscopy (DL) with a Macintosh blade. The similar success rate was probably because of proper positioning of the patients before DL. Unfortunately, there has been a recent trend among our trainees to use a VLS as a first choice intubation tool in the obese patient population. There is no doubt that these devices can reflect better laryngeal views when head, neck, and body positioning is suboptimal because axes alignment is not needed. They are, thus, more forgiving than DL when proper positioning was not assured. The routine use of VLSs as a first choice tool instead of DL, however, should be discouraged. This practice will lead to a gradual decrease, and subsequently less experience and confidence, when using DL for tracheal intubation in obese patients. It will risk an eventual loss of the skills needed to perform DL and the maneuvers, including proper positioning, that can be utilized to optimize visualization in this patient population. Andersen et al. are to be congratulated for drawing everybody’s attention to these facts. Conflict of interested: None.

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