Newly Published
Correspondence  |   February 2020
Current Difficult Airway Management: Not Good Enough!: Reply
Author Notes
  • Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan (T.A.). asaita@dokkyomed.ac.jp
Article Information
Correspondence
Correspondence   |   February 2020
Current Difficult Airway Management: Not Good Enough!: Reply
Anesthesiology Newly Published on February 25, 2020. doi:https://doi.org/10.1097/ALN.0000000000003209
Anesthesiology Newly Published on February 25, 2020. doi:https://doi.org/10.1097/ALN.0000000000003209
We appreciate the comments of Drs. Marymont and Vender1  on our recent Editorial2  addressing the article on a closed claims analysis of difficult tracheal intubation.3  Drs. Marymont and Vender are concerned because our statement in the Editorial2  that “[i]f difficult airway management is predicted, general anesthesia should not be induced before securing the airway” may be inconsistent with the American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway.4 
Although our remarks were orientated to an article3  centered on difficult tracheal intubation, our statement regarding securing the airway before induction of anesthesia does not necessarily mean awake tracheal intubation. We prefaced the statement as follows: “It is apparent from these cases that inadequate planning is a core issue. The airway must be assessed preoperatively, not only to predict difficult intubation, but also the risk of difficulty in ventilation through a facemask or supraglottic airway, difficulty in securing a surgical airway and risk of aspiration.”2  Clearly, there must be a degree of certainty regarding capacity to “secure the airway” in the unconscious patient (be it by use of a facemask, supraglottic airway, invasive airway, or tracheal intubation) before deciding to induce general anesthesia first. Hence, our statement, which does not mandate intubation before general anesthesia, is not inconsistent with the practice guidelines formulated by the American Society of Anesthesiologists.4