Airway management for tonsillectomy.

Editor—We read with interest the article on airway management for tonsillectomy, which concluded that there is widespread non-compliance in the use of disposable anaesthetic instruments. The authors quite correctly make the point that currently non-disposable surgical instruments are used. Surely, prion transmission is less likely to occur via anaesthetic than surgical instruments which are intrinsically contaminated with tissue. The current RCoA guidelines recommend the use of single-use instruments for anaesthesia in tonsillectomy, although reusable instruments are used for the actual operation. We feel that, before enforcing guidelines that have not been complied with nationally, a full assessment of whether the risk of prion transmission is clinically significant is necessary. In 2001, the Department of Health recommended that although there was no evidence of any patient being infected with variant Creutzfeldt–Jakob disease (CJD), precautions should be taken to reduce the ‘theoretical risk’. The use of single-use surgical instruments was abandoned after an increased risk of haemorrhage was identified by the National Prospective Tonsillectomy Audit (NPTA). Frosh recommended improved decontamination and the use of disposable surgical instruments, before the results of the NPTA. Improved decontamination should reduce the risk of CJD transmission and can be applied to both surgical and anaesthetic instruments. This also resolves the problem of substandard single-use instruments, as identified by the authors. It cannot be consistent to have one rule for surgeons and another rule for anaesthetists.