In Reply:-Recommendations enthusiastically promoting the insufflation of oxygen through fiberoptic instruments during intubation are ubiquitious in the literature on this subject. Considerable effort would have to be made to locate a monograph lacking such advice. It is, therefore, all the more remarkable that we were able to do so inadvertently in the case of Ovassapian and Mesnick's 1995 article. [1] They recommend insufflation in this paper, but correctly point out that it is mentioned only in a discussion of local anesthetic delivery. We apologize for misconstruing their advice.

The writers' observation that small size fiberscopes are a “poor choice” for routine adult use deserves emphasis. The larger instruments offer not only better suction but also improved optics, illumination, and handling characteristics. Further, the relatively tight fit of an 8-mm endotracheal tube on these full-sized instruments eliminates the “play” between scope and tube, which contributes to the occasional difficulty in advancing the tube over the scope into the airway. It is wise to reserve the small caliber instruments for patients who require a small endotracheal tube, such as the patient we described, [2] whose laryngeal caliber was markedly reduced by soft-tissue swelling.

Alexander A. Hannenberg, M.D.

Mark D. Hershey, M.D.

Department of Anesthesiology; Newton Wellesley Hospital; 2014 Washington Street; Newton, Massachusetts 02162

(Accepted for publication April 25, 1997.)

Ovassapian A, Mesnick PS: The art of fiberoptic intubation. Anesth Clin North Am 1995; 13:391-409.
Hershey MD, Hannenberg AA: Gastric distention and rupture from oxygen insufflation during fiberoptic intubation. Anesthesiology 1996; 85:1479-80.