Letters to the Editor A Convenient Way to Secure Intravenous, Arterial, and Other Lines on Extremities To the Editor: Currently, most IV and arterial lines are secured with adhesive tape, sutures, and dressings. These do not always provide enough secu- rity, however, and displacement still occurs. This is particularly important for patients requiring long-term care, as many have dif- ficult IV and arterial access. Disoriented, agitated, or restless pa- tients who are prone to pull on inserted lines also present a common problem. Finally, rambunctious children represent a third category of vulnerable patients. We would like to introduce a method used at our institution to optimize security of inserted lines and minimize the need for mul- tiple subsequent venous and arterial punctures. We use a pressure bag intended for invasive pressure lines. After inserting, dressing, and taping the IV or arterial lines, we place the patient’s extremity into a pressure bag, which is then inflated to a firm but nonocclusive level. A pulse oximeter probe is placed to ensure adequate blood supply and perfusion of the extremity (Fig. 1). This method serves two purposes as it prevents patients from destroying lines and secures the lines in place. We have not encountered any side effects or problems using our method in these patients. A possible limitation is the size of the extremity in overweight patients or small children (this could be possibly handled by varying the size of the bag). In conclusion, we found that use of a pressure bag to be a convenient, safe, and easily applied method to secure IV, arterial, or other lines on extremities of agitated, long-term care, or pediatric patients. Olga Blakley, MD George Mychaskiw II, DO Department of Anesthesiology, Surgery, and Physiology University of Mississippi School of Medicine Jackson, MS Remifentanil Is a Valuable Alternative to Contraindicated Neuraxial Analgesia in the Parturients To the Editor: We read with interest the Communication by Olufolabi et al. “A Preliminary Investigation of Remifentanil as Labor Analgesic” (1). The authors’ conclusion suggested that remifentanil is an unsuitable systemic analgesic for labor. Such a restrictive conclu- sion contrasts with several cases previously reported (2– 6). We currently use patient-controlled IV analgesia with remifentanil to laboring parturients who cannot benefit from neuraxial analge- sia. We observe correct analgesia during the first stage of labor and very few side effects (7). Our findings, in accordance with others, question the results of Olufolabi et al. (1). In their study, inability to produce acceptable pain relief could be related to the mode of drug administration and the choice of patients. Indeed, boluses administered by an anesthesiologist certainly had re- duced the success linked to the use of patient-controlled IV analgesia system. Also, they used remifentanil as an analgesic technique and not as an alternative to contraindicated neuraxial analgesia. Most of the women in the latter case are grateful to benefit from a technique providing better efficacy than IM injec- tion (4). In conclusion, remifentanil does represent an ideal systemic an- algesic for labor for parturients who cannot benefit from neuraxial analgesia. P. Lavand’homme, MD, PhD F. Veyckemans, MD F. Roelants, MD Department of Anesthesiology St Luc Hospital—UCL Medical School Universite Catholique de Louvain Brussels, Belgium References 1. Olufolabi AJ, Booth JV, Wakeling HG, et al. A preliminary investigation of remifentanil as labor analgesic. Anesth Analg 2000;91:606 – 8. 2. Jones R, Pegrum A, Stacey R. Patient-controlled analgesia using remifentanil in the parturient with thrombocytopaenia. Anaesthesia 1999;54:461–5. 3. Thurlow JA, Waterhouse P. Patient-controlled analgesia in labour using remifentanil in two parturients with platelet abnormalities. Br J Anaesth 2000;84:411–3. 4. Thurlow JA, Laxton C, Dick A, et al. A comparison of patient controlled analgesia using remifentanil with intramuscular pethidine for pain relief in labour. Int J Obstet Anesth 2000;9:200. 5. Blair JM, Hill DA, Fee JP. Patient controlled analgesia for labour using remifentanil: a feasibility study. Int J Obstet Anesth 2000;9:201. 6. Volmanen P, Akural E, Raudaskoski T, et al. Remifentanil in obstetric analgesia: dose assessment study [abstract]. International Monitor - Regional Anesthesia and Pain Therapy - Special Abstract Issue 19 th Annual ESRA Congress 2000;12:104. 7. Roelants F, De Franceschi E, Lavand’homme P. Patient-controlled intravenous analgesia using remifentanil in the parturient [abstract]. Anesthesiology 2000;92: A63. Unlighted Stylet Tracheal Intubation To the Editor: A recent review (1) indicated that all commercially available lighted stylets have disadvantages. Much of the world cannot afford them or other aids. An unlighted stylet can be as successful. The glottis is located by observing movements in the anterior neck or breath sounds along the tube instead of by transillumination by the lighted stylet. Unlighted stylet use mirrors the details outlined in the review article (1) for the lighted stylet. However, I employ a longer distal Figure 1. Extremities secured by pressure bags. Arrows indicate disposable pulse oximeter probe. ©2001 by the International Anesthesia Research Society Anesth Analg 2001;92:1355–9 1355