We thank the readers for their interest and comments regarding our recent work. The total intubation time was significantly longer in our study than in previous studies. We believe that this was due to the different intubation routes used and the different patient conditions. In our study, nasotracheal intubations were performed in patients with difficult airways, whereas in the previous studies, orotracheal and nasotracheal intubations were performed in patients without definite predictors of a difficult airway.
The readers introduced us to another lightwand device, the Trachlight™, which has two main advantages compared with ours: (1) There are different models of Trachlight and it can be used even in infants. (2) The light of the Trachlight is so bright that it allows intubation under ambient light or even in the pre-hospital environment. However, sometimes it is hard to determine whether the Trachlight is placed in the trachea or the oesophagus since the light is too bright.
The stylet used in our study was short and not suitable for the double-curve nasotracheal tracheal tube without any modification. We believe this problem can be solved using the simple and practical method introduced by Xue et al. Briefly, the nasotracheal tube is cut at the midpoint of the distal curve. After the nasotracheal intubation, a plastic connector is used to connect the two cut ends of the nasotracheal tubes and then firmly secured with adhesive tape. The stylet may control the former segment of the lightwand better, and by remodelling it into a ‘hockey stick’ configuration which is more favourable for patients with a high glottis. Moreover, with the guidance of the light spot, moving in and out of the tracheal tubes blindly is avoided.
The original work was supported in part by the National Natural Science Foundation of China (No. 81100768 ) and the Key Project supported by the Medical Science and Technology Development Foundation, Nanjing Department of Health (Nos. YKK11040 ; QRX11123 ) and Jiangsu Health International Exchange Programme.