Effects of glyceryl trinitrate on cerebrovascular autoregulation.

their interest in our article. First, we would like to apologize for mis-attributing the statement to the authors. The correct reference in our article was to 11 not 1 and it is not a direct quotation. We believe our survey provides sufficient evidence to raise concerns over the use of transtracheal ventilation using a high pressure source without control of airway pressure, but a survey lacking denominators cannot confirm or refute its lack of safety. In the absence of large randomized controlled trials comparing techniques, properly designed prospective cohort data collection may be sufficient. It is possible that the 4th National Audit Project of the Royal College of Anaesthetists which will, from September 2008, prospectively identify major airway complications throughout the UK, will provide such information. What our survey does illustrate is that the reality in the UK is that in the majority of hospitals, transtracheal procedures can only be performed using manual techniques. Assuming these techniques are only used for laryngeal surgery, we conclude that only 15% of respondents performed transtracheal techniques electively and only 7% have access to high-frequency jet ventilation. We agree the manual technique is ‘suboptimal’. However, if our experience is typical, it is likely that financial pressures prevent purchase of the more expensive equipment and suboptimal techniques are likely to be the norm in the UK for some time to come. As inferred in our paper, we agree that all anaesthetists should be familiar with transtracheal ventilation techniques. Our survey suggests, at least in the UK, that experience is unlikely to be achieved during elective ENT lists. Other solutions are necessary.