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We appreciate the interest in our article. In reply to Drs Gabbott and Sasada, several comments are necessary.
In the first paragraph of the letter, the authors state that "anesthesiologists routinely employ blind nasal intubation after the use of muscle relaxants." This is not true. Although it is possible to perform a blind nasotracheal intubation in an apneic patient, it is not easy, even in the best hands, and very few anesthesiologists would recommend this as a routine procedure. The blindly advanced endotracheal tube is more likely to be directed into the esophagus than the trachea in the apneic patient. We do not agree with the comment that the technique is "routinely" used by anesthesiologists after the administration of muscle relaxants.
In the second paragraph, the use of the LMA is recommended for failed intubations in the trauma patient. We would recommend extreme caution in using the LMA in trauma
Scannell G, Waxman K, Tominaga G, Annas C, Barker S. Orotracheal Intubation in Trauma Patients With Cervical Fractures-Reply. Arch Surg. 1994;129(10):1104-1105. doi:10.1001/archsurg.1994.01420340118024