A new blade for endotracheal intubation.

Sir,—Recently, difficulty was encountered during anaesthesia for a 75-year-old man who presented with hoarseness but no history of dyspnoea. Indirect laryngoscopy revealed a small tumour on the left vocal cord but the laryngeal aperture was adequate. Subsequently, the patient was anaesthetized for the purpose of direct laryngoscopy and biopsy. Premedication comprised atropine 0.6 mg and promethazine 50 mg i.m. 45 min before surgery. On the operating table, it was noted that the patient had difficulty in extension of the neck. Intubation of the trachea under local anaesthesia was not possible and tracheotomy was performed under local analgesia. On placing a pillow under the shoulders, the patient became restless and would not tolerate extension of the neck. The pillow was then removed and tracheotomy performed with great difficulty. After passing a tube through the tracheal stoma, anaesthesia was induced with thiopentone 300 mg and maintained with nitrous oxide in