Does propofol in combination with alfentanil provide stable anaesthesia in cardiac patients?

Sir,—Brock-Utne and Jaffe recommend the sitting position for fibreoptic intubation in the presence of a full stomach [1]. I would endorse this for most patients undergoing fibreoptic intubation, as there are several advantages in addition to those mentioned in their letter. The sitting position is more natural for the patient and allows face-to-face communication with the anaesthetist. This makes for a more relaxed patient with less need for sedation and thus a truly "awake" intubation. Any blood or secretions drain from the pharynx or can be swallowed more easily, making for a clearer view. It is also a more physiological position for the patient with obesity or respiratory or cardiac disease. The only objection is that the view is "the wrong way round", but with a little practice and imagination this is not a problem. Originally, I adopted the use of the sitting position for fibreoptic intubation because I copied the technique of physicians when performing fibreoptic bronchoscopy. On a recent visit to the Department of Anesthesiology at the University of Michigan, I was encouraged to find that their "Difficult Airway Clinic" endorsed this practice [2]. Presumbly, anaesthetists place their patients in the supine position from habit.