Airway alert information following difficult intubations

We read with interest the ‘Difficult Airway Society guidelines for the management of the unanticipated difficult intubation’ (Henderson et al. Anaesthesia 2004; 59: 675–694). We wish to draw attention to the importance of follow-up after difficult intubation. This process ought to involve counselling the patient and taking measures to prevent similar incidents in the future. We believe the airway alert form, introduced by Barron et al. [1], is an important tool that can be used to provide the necessary information to clinical staff in relation to future anaesthesia for the patient. Furthermore, the need for such information is doubly important in a case of unanticipated difficult intubation, in order to aim to optimise future airway management. However, previous studies have shown that follow-up of difficult intubation is not widely practised [1,2]. We provide all our patients who are Cormack & Lehane Grade 3 or 4 on direct laryngoscopy with an airway alert form and include the following information: pre-operative airway assessment; ease of face mask ventilation; description of findings and grade of the direct laryngoscopic view; equipment/manoeuvre that failed to achieve intubation; equipment/manoeuvre that successfully achieved intubation; ease of extubation; special postoperative airway care requirements; and future plans. An abundance of useful information is available on the Difficult Airway Society website (http://www.das.uk.com).