We thank the authors of these letters for their comments that help to clarify the importance of our study to the readers. As regards the letter from Drs. Xue, Cui, and Cherng, we used a 6.5- to 7.5-mm inner diameter endotracheal tube and a laryngoscope with a Macintosh blade, size 3 in all patients in this study. Moreover, all the cases in which intubation was unsuccessful by the novices were successfully intubated by the anesthesiologists with the use of size 3 Macintosh blade. All the patients in this trial were selected by using the stated inclusion criteria, and their characteristics were controlled as shown in table 1 of original article.1 We cannot comment on the effect of Macintosh blade size on the results of this trial, because it was not varied. The stylet bend angles started with 40 to 50 degree and could be changed by the assistants according to the requirement of the operators.
The enrollment of the optimal external laryngeal manipulation to improve laryngeal views was required in some cases of both groups. We agree that the placement of the flashlight (Fenixlight Limited, Shenzhen, China) itself may have a positive effect on the exposure of the glottis compared the patient without any external laryngeal manipulation in direct laryngoscopy group.
As regards the letter from Dr. Cherng, we agree as noted above that placement of the flashlight and any pressure applied could have altered or improved exposure of the glottis.