Declaration of Interest Declaration of Interest Size May Matter

Editor—We read with interest the article by Quinn and colleagues, which adds to our evolving knowledge of obstetric failed intubation. The paper confirms a lot of our own findings. Some of these findings are replicated in the USA, Brigham’s Women’s Hospital paper. Failed intubation rates are low in countries that have a high rate of general anaesthetic usage, such as South Africa: failed intubation rate—1:750. Similarly, those countries where obstetric anaesthesia is administered by senior anaesthetists such as the USA also have a lower failed intubation rate. 6 Our hospital houses a tertiary maternity unit with deliveries in the region of 8500 per annum. This large number of deliveries has ensured that the number of general anaesthetics administered remained sufficient to offer training opportunities and hence a low failed intubation rate. In our paper, a retrospective audit was performed of all obstetric general anaesthetics in our hospital over an 8 yr period to determine the incidence of difficult and failed intubation. Data were collected from a number of sources to ensure accuracy. A total of 3430 rapid sequence anaesthetics were given. None of the patients had a failed or oesophageal intubation, making the 95% confidence interval between 0 and 1:1143. We attributed the low incidence of failed intubation and airway complications to the above average numbers of general anaesthesia in our hospital, senior cover, and specialized anaesthetic operating department assistants. The rate of failed intubation is a key outcome measure of the quality of care provided during obstetric general anaesthesia. This standard of care is likely to show significant variation between institutions, which will only be evident from continuous audit over many years. It is vital to monitor this indicator as surveillance for significant changes in trends and to encourage further improvements in patient safety.