[Airway management in Ludwig's angina: what is necessary and what is sufficient condition?]

Dear Editor,

I’ve followed the topic of “Airway management in Ludwig's angina” in your valuable journal. As Fellini et al. described, decision making regarding airway management in such a disastrous situation will be based on clinical feature, urgency of the case, and technical availability. There is a rule in our routine practice as anesthesiologists: there is not the safest anesthetic agent, nor the safest anesthetic technique; there is only safest anesthesiologist! So being an expert anesthesiologist is the necessary condition, but not sufficient, for making a best decision for airway management in patients with compromised airway. Maintaining spontaneous breathing is a key element in airway management of a patient with compromised airway. Accordingly, when I read a letter of Guedes, I understood that the situation must have been completely different. Co-administration of clonidine, fentanyl and midazolam may put the patient at risk of collapsing the airway. Because “you cannot fight the success”, successful airway management in this patient can imply that the best person who can make the best decision about the patient is the one who is at the bedside. In other words, being in the scene is the sufficient condition for making the best decision regarding airway management method in patients with Ludwig's angina or any other kind of compromised airway.

Conflicts of interest

The author declares no conflicts of interest.