From: Marcelo Ramos
Sent: Tuesday, April 13, 2004 1:04 PM
Subject: SOS problems and solutions...
I am using the Shikani SOS device in almost all my intubations,
and I work along with 10 anesthesiologists. They are beginning to
train the use of the device.
Surprisingly (maybe it is not a real surprise?) most of them were
able to perform a proper endotracheal intubation with the device
in the first or second use of the SOS, even with NO experience at
all about the device! Maybe it is due to the fact that they are
all very skilled anesthesiologists and they are very knowledgeable
about pharyngeal anatomy, but I believe that it shows that the device
is really useful even in not trained hands (not the case of the
fiberscope).
To be really sincere they even want me to sell the device to the
whole group, so that it can be available to every one in case of
a difficult intubation.
Among the 10, 5 got skilled in the first 2 uses, 3 cannot intubate
yet, but they tried only a few times. 2 did not have the opportunity
to train.
The fact that I am using it almost daily, and that I did a lot of
intubations with the device shows the reusable nature of the device.
It can be re used almost indefinitely! Only once I felt the need
to bend the curvature and after this used I returned it to the original
shape.
Maybe the device should replace the conventional laryngoscope in
the near future (if not replace, complement the basic anesthetic
material).
I use a light source with a storz optic cable with an adaptor that
needs a rubber to fit in the light port of the SOS. Since it is
working well (Reichmback light source for plastic surgery or illumination
device for ENT surgery) I do not feel the need to buy the site lite
now. I know that the site lite would give me more flexibility and
freedom, but I think I cannot buy it by now, maybe I will buy it
later.
It is a little more difficult to intubate using a video device than
using the eyepiece, but on the other hand everyone in the room is
able to SEE what is happening and it is so exiting to show how we
perform the endotracheal intubation.
There are other considerations about the device that I am sure deserves
further consideration, and I recommend you to sponsor a research
about it: The endotracheal intubation with the SOS, DIFFERENT from
the conventional laryngoscopy does not need muscle relaxation, and
more important DO NOT generate the typical hypertensive and tachicardic
response. That is an important diference special for cardiac cases.
I strongly believe that in a near future it will be indicate to
replace conventional laryngoscopy for SOS intubation in critical
cardiac (coronary insufficiency) cases (regardless of the degree
of difficult anticipated to the intubation. It is a case in which
a device that was designed for one goal (facilitate difficult intubation)
reach another goal (provide a response less endotracheal intubation.
Believe me, it DOES DESERVE further considerations.
We experienced a time (during last March) when no Succinilcholine
(Sch) was available in the market in Brazil, laboratories stopped
the production in order to raise its price. Since Sch became “gold”,
we develop a protocol to intubate with no relaxing drug. - (Especially
morbidly obese patients, in which we are not really sure we are
going to reach a successful intubation) - Surpise!: with the SOS
we never needed to use the Sch! I intubated all my obese patients
with propofol and remifentanil alone and only used relaxants after
the cuff was inflated in the trachea! Not only the physiologic response
is grossly attenuated with the use of the SOS, but also the somatic
(cough, laryngospasm, etc) is also abolished by this technique.
Now we do have a almost regular supply of Sch, but we “got
used” to the safer option of a “relaxant less SOS intubation”
Thank you for your interest.
A hug from Brazil
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