We are pleased to note that Felipe Urdaneta, M.D., was motivated to comment on our recent Images in Anesthesiology manuscript.1Dr. Urdaneta correctly points out that evaluation of an airway is not always obvious. This fact highlights his caution that the ability to predict ease of visualization of the glottis is not assured. The references included in Dr. Urdaneta's letter to the editor are among the many in the anesthesiology literature that caution against a “glib” approach to “easy” tracheal intubation, especially when the laryngoscopic view is obscured as was the case with our patient.

Because tracheal intubation is not assured when airway visualization may be obscured, the clinical management safety mandate is to maintain the patient's spontaneous ventilation and have an otolaryngologist in the operating room with the full gamut of airway equipment to manage the difficult airway.

Schwartz AJ, Javia L, Stricker PA, Nadeau P, Nguyen C: Intermittent airway obstruction in a neonate. ANESTHESIOLOGY 2011; 115:630