A reply

Abstract

We welcome the opportunity to reply to the comments made by Drs Menzies and Frerk. They are concerned that in some of the patients we described, difficult intubation should have been anticipated and alternative (awake) techniques employed. The crux of the article, however, was that in these cases, consultants, middle grades and trainees had not anticipated insurmountable difficulty in intubating these patients' tracheas – and when they did encounter difficulty, the Aintree Catheter technique proved very useful in rescuing the situation. Whether or not they should have anticipated difficulty is another matter. The series was presented primarily as a discussion around the Difficult Airway Society guidelines for ‘unanticipated difficult intubation during routine induction of anaesthesia’– Plan B: secondary intubation plan [1]. The report centred on the utility of the Aintree Catheter in managing failed intubation attempts when they occurred, not on how to avoid them in the first place. We agree that some of the patients could have been better managed initially using awake intubation. Their second point is that some of the patients should have been woken up and intubation attempts abandoned. We can re-assure them that none of the patients suffered failed oxygenation or ventilation using the classic laryngeal mask airway and so, in accordance with the secondary intubation plan, intubation via the classic laryngeal mask airway was attempted. Case 1 involved failed rapid sequence induction, but in the context of emergency airway protection in a trauma victim, not to facilitate surgery, and so awakening the patient and postponement was not applicable. We agree with Menzies and Frerk that patients who are potentially difficult to intubate should have their airways secured awake but, equally, we feel sure they would agree that doctors continue to fail to anticipate difficult intubation. This does not detract from our demonstration that the Aintree Catheter is useful in dealing with this very difficult circumstance, however, it should arise.