To the Editor:—
The statement of Vincent J. Collins, MD, (195:47, 1966) that, "Failure to use an endotracheal tube [for tonsillectomy] may be construed as evidence of negligence" should not stand unchallenged. The review of Alexander et al1 referred to in your editorial on "Tonsillectomy Mortality" (194:824, 1965) indicated that during a 12-year period in the city of Baltimore the insufflation technique was used for eight of 12 patients who had anesthesia-related deaths, and the endotracheal technique was used for four patients in the series. Since the vast majority of tonsillectomies in that community are conducted with an oropharyngeal insufflation technique and the minority with endotracheal anesthesia, these data do not document the absolute safety of the endotracheal technique, nor do they represent an absolute contraindication to the insufflation technique. As a matter of fact, during the past four years of that series, there was only one
Phillips OC. Tonsillectomy Mortality. JAMA. 1966;195(9):788–789. doi:10.1001/jama.1966.03100090122039
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