In Reply:--We agree that jet ventilation with suitable equipment will maintain ventilation and oxygenation under the circumstances and that it is a more widely applicable method. We sought a small diameter hollow tube exchanger, but one was not readily available. Negative pressure ventilation, as Cooper states, requires a patent airway. The upper airway of our patient was easily maintained, and we did not think that the coexistence of a 7-Fr Mettro (Mizus Endotracheal Tube Replacement Obturator, Cook Critical Care, Bloomington, IN) and a 3.5-mm fiberscope would cause airway obstruction. However, we also were prepared to perform fiberscope nasal intubation under oral mask ventilation [1]in case negative pressure ventilation was unsuccessful or we failed in exchanging endotracheal tubes under negative pressure ventilation. We presented negative pressure ventilation as another possible option on such occasions.

Rieko Sumiyoshi, M.D.; Staff Anesthesiologist.

Tetsuya Kai, M.D.; Chief Anesthesiologist; Department of Anesthesiology; Fukuoka City Hospital; 13-1 Yoshizuka-Honmachi, Hakata-ku; Fukuoka 812, Japan.

(Accepted for publication March 6, 1995.)

Nagaro T, Hamami G, Takasaki Y, Arai T: Ventilation via a mouth mask facilitates fiberoptic nasal tracheal intuhation in anesthetized patients. ANESTHESIOLOGY 78:603-604, 1993.