In Reply:-I agree that whenever difficult tracheal intubation is predicted, we should reserve the administration of muscle relaxants until we have demonstrated the ability to ventilate the lungs.

However, the aim of our case report [1] was not to discuss the best algorithm for treatment of the patient with a difficult airway, which should be individualized according to the degree and cause of difficulty, [2] but to show that the laryngeal mask airway may be a useful device for ventilation in the cannot-intubate, cannot-ventilate situation.

Anis Baraka, M.D., F.R.C.A., Professor and Chairman

Department of Anesthesiology, American University of Beirut

Beirut, Lebanon

(Accepted for publication January 3, 1997.)

Baraka A: Laryngeal mask airway in the cannot-intubate, cannot-ventilate situation (letter). Anesthesiology 1993; 79:1151-2.
Practice guidelines for management of the difficult airway. A report by the ASA task force on management of the difficult airway. Anesthesiology 1993; 78:597-602.