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Extended roles for videolaryngoscopy

but merits further discussion. Firstly, as there is no uniform, objective definition of ‘difficult mask ventilation’ [1, 2], the evidence from which Patel draws his conclusions is undermined by the diversity of definition and the subjectivity of measurement. Secondly, difficult mask ventilation occurs rarely, making it difficult to study in sufficiently powered studies. The meticulous work by Sachdeva et al. illustrates this [3], being the largest such study to date, but including only 125 participants. Patel suggests that test ventilation may lighten anaesthesia and promote difficulty. Although a valid concern, there is no proof that this actually happens. I seldom test-ventilate, but occasionally do so to guide the choice of neuromuscular blocking drug, failed test ventilation being a trigger for suxamethonium administration [4]. Patel objects that it is ‘not inconceivable’ that serious hypoxia will occur before spontaneous ventilation resumes after suxamethonium, which is correct but preferable to prolonged hypoxia. Finally, Patel is bold to state that difficult mask ventilation ‘never deteriorates’ after neuromuscular blocking drugs are administered, when anaphylaxis and bronchospasm are recognised complications of these drugs, and which can make difficult mask ventilation impossible.