Correspondence  |   December 2004
Unanticipated Difficult Airway: What about Emergency Cases?
Author Affiliations & Notes
  • Thomas Heidegger, M.D.
  • * Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Article Information
Correspondence   |   December 2004
Unanticipated Difficult Airway: What about Emergency Cases?
Anesthesiology 12 2004, Vol.101, 1484-1485. doi:
Anesthesiology 12 2004, Vol.101, 1484-1485. doi:
To the Editor:—
We read with great interest the recent report on unanticipated difficult airway in anesthetized patients by Combes et al.  1 The article confirms that by strictly adhering to a simple predefined algorithm most problems occurring during management of an unexpected airway can be solved. This has already been proven in two other large prospective studies.2,3 Using the gum elastic bougie as the first choice in a “can ventilate” but “cannot intubate” situation is a well-established technique, especially in Great Britain, and, of course, is much cheaper than, for example, a fiberoptic bronchoscope.4 
However, the study raises several questions. The algorithm was only applied in elective cases. It would be very informative whether this airway algorithm was also used in emergency situations (out of the study) and how they succeeded.
The authors did not mention the distribution of intubations across surgical disciplines in detail although it is well known that many difficulties occur in Ear, Nose and Throat departments.
The authors correctly pointed out that the results are not transposable to patients with an anticipated difficult airway. Nevertheless, it would be very interesting how they managed these scenarios and how they decided what is an anticipated difficult airway and consequently excluded them from the study.
* Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Combes X, Le Roux B, Suen P, Dumerat M, Motamed C, Sauvat S, Duvaldestin P, Dhonneur G: Unanticipated difficult airway in anesthetized patients: Prospective validation of a management algorithm. Anesthesiology 2004; 100:1146–50Combes, X Le Roux, B Suen, P Dumerat, M Motamed, C Sauvat, S Duvaldestin, P Dhonneur, G
Parmet JL, Colonna Romanso P, Horrow JC, Miller F, Gonzales J, Rosenberg H: The laryngeal mask airway reliably provides rescue ventilation in cases of unanticipated difficult tracheal intubation along with difficult mask ventilation. Anesth Analg 1998; 87:661–5Parmet, JL Colonna Romanso, P Horrow, JC Miller, F Gonzales, J Rosenberg, H
Heidegger T, Gerig HJ, Ulrich B, Kreienbühel G: Validation of a simple algorithm for tracheal intubation: Daily practice is the key to success in emergencies: analysis of 13,248 intubations. Anesth Analg 2001; 92:517–22Heidegger, T Gerig, HJ Ulrich, B Kreienbühel, G
Latto IP, Stacey M, Mecklenburg J, Vaughan RS: Survey of the gum elastic bougie in clinical practice. Anaesthesia 2002; 57:379–84Latto, IP Stacey, M Mecklenburg, J Vaughan, RS