A reply

Abstract

We thank Drs Ball and Stallard for their letter related to our article 1 in which we describe a new application of ultrasound in airway management. We used a guidewire because, in our department, we have had better results compared with epidural catheters, which occasionally become kinked or coiled. We use the soft tip of the guidewire and continuously observe the tumour and the possibility of guidewire tension by direct laryngoscopy. If we feel resistance and too much tension on the guidewire, leading to the possibility of a ’cheese wire effect’ 2, we stop and revert to ‘Plan B’, which could be a ‘front of neck’ technique. We did not choose cricothyrotomy or tracheostomy as a ’Plan A’ because they are more invasive and take longer to perform compared with retrograde intubation. Our main objective using ultrasound was to make retrograde intubation safer and more predictable. In conclusion, retrograde ultrasound-guided intubation is quickly learned, the skills easily maintained and it may be a rapid and less invasive alternative to a surgical airway in many scenarios.