Reply from the authors

Abstract

Editor—We thank Drs Davies and Bonnett for their interest in the work of the NAP4 project team.1Cook TM Woodall N Ferk C Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia.Br J Anaesth. 2011; 106: 617-631Abstract Full Text Full Text PDF PubMed Scopus (1170) Google Scholar Patients with beards are recognized to have an increased risk of difficult mask ventilation.1Cook TM Woodall N Ferk C Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia.Br J Anaesth. 2011; 106: 617-631Abstract Full Text Full Text PDF PubMed Scopus (1170) Google Scholar 2Langeron O Masso E Huraux C et al.Prediction of difficult mask ventilation.Anesthesiology. 2000; 92: 1229-1236Crossref PubMed Scopus (671) Google Scholar Male patients are also recognized to be at increased risk of both difficult mask ventilation and difficult laryngoscopy.1Cook TM Woodall N Ferk C Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia.Br J Anaesth. 2011; 106: 617-631Abstract Full Text Full Text PDF PubMed Scopus (1170) Google Scholar 3Lundstrom LH Moller AM Rosenstock C Astrup G Gatke MR Wetterslev J Avoidance of neuromuscular blocking agents may increase the risk of difficult tracheal intubation: a cohort study of 103 812 consecutive adult patients recorded in the Danish Anaesthesia Database.Br J Anaesth. 2009; 103: 283-290Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar NAP4 identified an excess of males in reported cases of major airway complications: 67% of all patients reported to NAP4, 62% of anaesthesia reports, and 58% of the cohort in intensive care units were male. We did not enquire about facial hair for all reported cases; however, regarding mask ventilation, we asked if this was difficult and if it was whether the cause was a beard interfering with mask seal. Of 131 anaesthesia reports which answered the question about mask ventilation, 77 (59%) reported that it was difficult. In only two cases was this reported to be due to a beard preventing a good seal. These two cases were (i) a case of aspiration likely due to light anaesthesia in an obese patient managed with a laryngeal mask and (ii) postoperative airway obstruction in an obese patient emerging from laryngeal mask anaesthesia for perineal surgery. There were therefore no cases reported to NAP4 where the primary airway event arose from difficult mask ventilation caused by a beard. The male gender appears to increase the risk of difficult mask ventilation, difficult laryngoscopy, and major airway complications. Having a beard also appears to increase the risk of difficult mask ventilation and perhaps difficult laryngoscopy. However, on the basis of NAP4, we conclude that it is not beardedness per se that leads to most major airway complications in males. None declared.