We would like to thank Dr. Sanfilippo et al. for their thoughtful comments regarding our recent article in Anesthesiology.1  We do agree that our phrase, “proper anesthetic induction” does not give a clear sense of what occurred during induction and intubation. However, because of word-count limits, we were unable to elaborate further. More importantly, we wanted to focus on the usefulness of a novel imaging modality, virtual laryngo-tracheo-bronchoscopy, in the management of complex airway scenarios.

We agree that a combined laryngo-bronchoscopic approach can help in managing complex airways. However, there are two important considerations. First, the approach requires two trained operators, who may not always be readily available. Second, this combined approach is more useful in patients with upper airway pathologies; our patient had a lower airway pathology.

On the basis of the computed tomography measurements, we had estimated that a size 5.5 endotracheal tube could be placed across the tracheal stenosis and that there was relatively low risk for dynamic airway collapse. Therefore, awake fiber-optic intubation was deemed unnecessary. However, to ensure that we did not end up in a “cannot ventilate-cannot intubate” situation, we planned to do an inhalational induction with sevoflurane while maintaining spontaneous ventilation. Intubation using a videolaryngoscope was unremarkable, with the tube passing easily through the stenosed segment.

The authors declare no competing interests.

Endoluminal computed tomography: A novel technology for assessment of large airway pathologies.