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Death/BD in claims from difficult airway management associated with induction of anesthesia but not other phases of anesthesia decreased in 1993-1999 compared with 1985-1992. Development of additional management strategies for difficult airways encountered during maintenance, emergence, or recovery from anesthesia may improve patient safety.

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Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries. Awareness and avoidance of the fire triad (oxidizer, fuel, and ignition source) is essential to prevent on-the-patient fires.

We thank Drs Sorbello and Frova for their interest in our work on introduc-ers. It appears that they have largely misinterpreted our study on the Frova introducer.Firstly, they appear to have misunderstood the patient selection method used in our study. The Frova introducer was used in a series of cases presenting with difficulty in intubation. Consequently, it is not at all surprising that 54 patients (27%) in our study had either grade 3a, 3b or 4 view as inadequate view of larynx was one of the selection criteria. Furthermore, Sorbello and Frova appear to have failed to appreciate that the users of the Frova introducer in our study were clinicians and not the researchers. The decision whether or not to use the Frova introducer was made by clinicians faced with poor laryngeal view. In addition, they have misrepresented the number of (1a) T T T Direction of force PROXIMALLY Resulting movement at the TIP E A vc Tr Es T E A vc Tr Es E vc A Tr Es E A vc Tr Es (2a) (3a) (2b) Figure 1Frova introducer principle shown in picture sequence 1a, 2a and 3a; in this sequence note the force direction, its transformation and the avoidance of impingement. Figure 2b demonstrates the effect of shaping the Frova introducer. Here note absence of force direction transformation and anterior commissural impingement.

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Claims related to central catheters had a high severity of patient injury. The most common complications causing injury were wire/catheter embolus, cardiac tamponade, carotid artery puncture/cannulation, hemothorax, and pneumothorax.