In Reply:-I thank Dr. Auden for his interest in my case report. I really wanted to stress three points by reporting this tragic event.

1. Every anesthesiologist should be aware of a possible upper cervical instability in this specific patient population.

2. I recommend an accurate diagnostic procedure concerning the cervical region, including exploration, flexion-extension series, and computed tomography. If a patient has signs of cervical instability, a discussion with the neurosurgeon is warranted.

3. In addition, in the case of negative radiologic findings, intraoperative management must be done with extreme care and should include the use of a cervical collar, flexible fiberoptic tracheal intubation, and accurate postoperative monitoring.

Gerhard Redl, M.D.

Department of Anesthesiology; Orthopedic Hospital Vienna-Speising; Vienna, Austria

(Accepted for publication March 12, 1999.)