In Reply:-Drs. Baraka, Salem, and Ninos make an interesting and valid point, i.e., apneic oxygenation via insufflation of oxygen through a pharyngeal catheter is a low-risk, possible high-benefit method of increasing the duration of Normoxia during apnea that follows preoxygenation. I assume that Drs. Baraka, Salem, and Ninos use this method when they have a high index of suspicion of difficulty with management of the airway (for any reason) preoperatively, because one would not want to need to locate an appropriate catheter (and connections to an oxygen source) while trying to solve a “cannot-ventilate, cannot-intubate” situation. Another method that I have used very occasionally to prolong the duration of normoxia during apnea is to insert a 2-inch 16-gauge catheter through the cricothyroid membrane preinduction, electively, using local anesthesia and achieve apneic oxygenation by insufflation of oxygen through this catheter. In addition, the transcricothyroid-membrane, 16-gauge catheter provides an immediate-ventilation plan B by connection to a jet ventilator preset at 25 psi using a 0.5-s inspiratory time. Wishing to avoid further trivial semantic debates, [3,4]I would be the first to admit that this preproblem solution could also be considered as an atraumatic form of a very early, aggressive postproblem solution.
Jonathan L. Benumof, M.D.
Professor of Anesthesia; Department of Anesthesia; UCSD Medical Center; La Jolla, California
(Accepted for publication September 2, 1998.)