To the Editor:-It is an advantage to know that a patient has a difficult airway. Mark and her colleagues established a register of such patients ( and encouraged Medic-Alert identification. [1]We would like to suggest video material as an additional strand of information about patients in whom fiberoptic laryngoscopy is difficult. We were asked to anesthetize a patient with Klippel-Feil syndrome, who had previously undergone transoral surgery for excision of the odontoid peg and the base of the clivus. She told us that an awake fiberoptic intubation at another hospital had been abandoned after 3 h because laryngoscopy was impossible. We found that awake nasal fiberoptic laryngoscopy was possible, but difficult due to nasal and palatal adhesions and a protruding clivus. The overall effect was of several false passages.

A prior viewing of the endoscopy would have made the procedure easier. Because we make video recordings of fiberoptic intubations for teaching purposes, we gave the patient a copy of the video, which can be viewed by any anesthesiologist caring for her in the future. We also retained a master copy of the tape. Providing selected patients with a video of their airway anatomy seems to us to be a useful and relatively inexpensive contribution to patient safety.

H. Owen-Reece, B.Sc., F.R.C.A., I. A. Calder, F.R.C.A., Department of Neuroanaesthesia, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1 3BG, United Kingdom.

(Accepted for publication August 19, 1996.)


Mark L, Schauble J, Gibby G, Drake J, Turley S: Effective dissemination of critical airway information: The Medic Alert national difficult airway/intubation registry, Airway Management: Principles and Practice, Edited by Benumof J. New York, Mosby, 1995, pp 931-43.