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Changing double‐lumen tracheal tube curvature

We read Yao et al.’s article comparing the McGrath Series 5 videolaryngoscope and Macintosh laryngoscope for double-lumen tracheal tube (DLT) placement with interest [1], and would like to invite the authors to reply to several comments. Firstly, the distal 10-12 cm of the DLT was curved through 90° in the McGrath group using a malleable stylet to facilitate the passage of the tip into the glottis, but it is unclear why the authors thought that this unique curvature would assist with correct placement of a DLT. Although such curvature may assist with passage of the DLT tip into the glottic opening, it is likely to have made advancement within the trachea more difficult and could have contributed to the increased intubation time. The 90° anterior curvature of the distal tube in the McGrath group would have also led to loss of the proximal curvature, so could have contributed to DLT misplacement. In order to facilitate the placement of the DLT in the McGrath group, the authors used either sequential rotation [2] or a left-to-right rotation maneouvre [3], which could have misoriented the DLT and contributed to its misplacement. Do the authors think that maintenance of the 90° anterior curvature in the Macintosh group, thereby facilitating orientation and placement, could have contributed to the shorter mean intubation times and lower incidence of DLT malposition seen in this group? Videolarygoscopy is associated with lower forces applied during intubation [4], resulting in a reduced incidence of sore throat compared with Macintosh laryngoscopy [5]. How do the authors account for the lack of difference in incidence of sore throat found between the groups in their study?