We read with interest the article in the August 1993 issue of the Archives.1 It is now clear that, in experienced hands, orotracheal intubation with manual in-line stabilization is the initial method of choice for urgently securing the airway in the trauma patient with suspected cervical spine injury. We wish to take issue, however, with the comments regarding nasotracheal intubation. We accept that the technique is aided by a spontaneously breathing patient, but this is not absolutely necessary, since many anesthesiologists routinely employ blind nasal intubation after the use of muscle relaxants. We would support the argument that the procedure is fraught with difficulty and problems in those not experienced in the technique.
Concerning the management of failed emergency intubation in the trauma patient, we would like to draw attention to an airway device widely used in Great Britain, which is gaining popularity in the United States. The laryngeal