In Reply:

On behalf of the American Society of Anesthesiologists (ASA) Task Force Management of the Difficult Airway and the ASA Committee on Standards and Practice Parameters, we thank Drs. Levine, DeMaria, Wilson, and Hebbar for their thoughtful Letters to the Editor regarding the Practice Guidelines published in February 2013.1  Drs. Levine and DeMaria suggest that the Difficult Airway guidelines should specifically call for a consideration of the risk of gastric aspiration. Drs. Wilson and Hebbar provide several suggestions for modifying the Difficult Airway Algorithm.

These letters exemplify the importance of the practitioners’ role in ASA Practice Parameters. The Committee on Standards and Practice Parameters listens very carefully to the clinical concerns of ASA members and leaders. These concerns guide the Committee to the selection of new practice parameters. During the process of guideline development, practitioners play a critical role by reviewing drafts, responding to on-line surveys, and providing commentary at open forums, caucuses, and reference committee hearings. After guidelines have been approved by the House of Delegates, practitioners make continuing contributions by testing the guidelines in daily practice. This real-world testing guides the focus and timing of subsequent revisions … or the occasional “retirement” of parameters that no longer provide useful guidance.

Our ASA methodologists carefully record and categorize practitioner comments. This material is studied by the Committee on an annual basis. Commentary is always welcome, and can be sent to the Chair of the Committee on Standards and Practice Parameters, to Task Force Chairs or Members, or to our Methodology Team.

These letters also provide an opportunity to review the intent of practice parameters. The ASA regards practice parameters as basic—not exhaustive—recommendations that assist both the practitioner and patient in making beneficial decisions about health care. Practice parameters are not offered as standards or absolute requirements. The recommendations found in practice parameters can be adopted, modified, or rejected according to clinical needs and constraints.

Once again, we thank our four colleagues for their insights. And we look forward to additional commentary and suggestions from ASA members.


Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.