We appreciate the comments of Drs. Takenaka and Aoyama about our article regarding the use of Macintosh blade No. 2 to be used for better laryngeal view in adult patients with a short (<5 cm) thyromental distance, who may be difficult to intubate with a regular blade.1They suggest that, because of the normal size of maxilla in adults with micrognathia, the Macintosh blade No. 2 might get into the oral cavity at the point of placement for optimal position required to lift the laryngeal soft tissues and could fail to give a good view for intubation. We have found that, when placed correctly in preepiglottic space from the right side of the tongue, displacing the whole tongue to the left of blade, the Macintosh curved blade No. 2 can be easily rested on the left premolars. We emphasize that the laryngoscopy method by making a fulcrum on the teeth is not recommended, as it can contribute to broken teeth or damage to enamel. The correct way is to pull the laryngoscope anteriorly and the soft tissue up in the mandibular space to visualize the glottis. The whole blade can only get into the oral cavity if the blade is placed over the tongue and not by the side of it. We do agree that if the blade completely gets into the oral cavity, the view might be difficult, but we have not encountered this problem.

*Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. mukesh_tripathi@yahoo.com

Tripathi M, Pandey M: Short thyromental distance: A predictor of difficult intubation or an indicator for small blade selection? Anesthesiology 2006; 104:1131–6