Sohan Lal Solanki1, Jeson R Doctor1. 1. Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Sir,We read with interest the article by Mahfouz et al.[1] on cannot intubate cannot ventilate (CICV) scenario in an infant for airway assessment. We congratulate the authors for their successful management of CICV in this case. However, we have a few concerns regarding the management of this case.This 6-month-old baby was brought to the hospital with difficulty in breathing and severe stridor, and having suprasternal and intercostal recessions with conducted sounds on auscultation. The child was not maintaining oxygen saturation above 90% with 4 L of oxygen. In such a condition, a preoperative computed tomography scan which can clearly show the airway anatomy and if facility is present, an added virtual bronchoscopy (VB) can obviate the need for airway assessment under general anesthesia. VB is a noninvasive, uncomplicated and reproducible method in patients with an indication for airway assessment and could be used clinically as a safer alternative.[2]Airway guidelines for children are for an unanticipated difficult airway and not for anticipated difficult airway or lower airway obstruction as in the present case.[3]