R. Sparrow Morriston Hospital, Swansea, UK Email: robert.sparrow@wales.nhs.uk M. A. Oliver University Hospital of Wales, Cardiff, UK The OS introducer has received funding from AgorIP (Swansea University, Wales. UK), and has a registered patent in the UK. Efficacy and safety studies are due to com- mence soon. Previously posted on the Anaesthesia correspondence website: www.anaesthesiacorrespon dence.com. References 1.  Angerman S, Kirves H, Nurmi J. A before-and-after observational study of a protocol for use of the C-MAC video- laryngoscope with a Frova introducer in pre-hospital rapid sequence induction. Anaesthesia 2018; 73: 348–55. 2. Trimmel H, Kreutziger J, Fitzka R. Use of the GlideScope ranger video laryngoscope for emergency intubation in the prehospi- tal setting: a randomized control trial. Critical Care Medicine 2016; 44: 470–6. 3. Hodzovic I, Latto I, Wilkes A, Hall J, Mapleson W. Evaluation of Frova, single- use intubation introducer, in a manikin. Comparison with Eschmann multiple-use introducer and Portex single-use intro- ducer. Anaesthesia 2004; 59: 811–16. 4. Master J, Rope T. Suction-tube facilitated videolaryngoscopic intubation. Anaes- thesia 2015; 70: 1003. doi:10.1111/anae.14351 Is the C-MAC videolaryngoscope plus Frova introducer suitable for intubating the trachea of every patient? We congratulate  Angerman et al. for achieving high first-attempt intuba- tion success by combining C-MAC videolaryngoscopy and a Frova intu- bating introducer during standard- ised rapid-sequence induction [1]. We would like to ask the authors some questions about their study. The authors recommend using videolaryngoscopy and a Frova catheter routinely in each patient, but we wonder whether video- laryngoscopy provides false reassur- ance about straightforward airway management, such that anaesthetists overlook the importance of careful examination, difficult airway predic- tion and extubation planning [2]? Many algorithms have been dev- eloped as ‘salvage’ guides for difficult direct laryngoscopy. Some of these re- cognise videolaryngoscopy as a rescue procedure. When videolaryngoscopy is used as the primary procedure, it can be unclear which algorithm to fol- low [2]. The fact that one patient with trauma and one with epiglottitis could not be intubated in the study group, requiring surgical tracheostomy, indi- cates this to be a problem. Considering the methodology of the study, do the authors con- sider that the use of a Frova intu- bating introducer with C-Mac videolaryngoscope is suitable, given that insertion of a tracheal tube through the glottis might be made more difficult by the Frova device, particularly when mouth opening is limited [2]? Aziz et al. have suggested that videolaryngoscopy may be problem- atic when there is surgical scar- ring, radiation-related changes and changes in the anatomy of neck with the presence of a mass, and alterna- tive intubation methods should con- tinue to be used for these patients [3]. Professionally, should we really consider abandoning direct laryn- goscopy when videolaryngoscopy may be inappropriate under certain circumstances? In addition, use of a Frova intubating introducer is not without risk, for example, epiglottis and glottis damage, and sinus piriformis, trachea and bronchus perforation. If used routinely, these risks are likely to become more prevalent [4], and, (a) (b) (d) (c) Figure 1 The OS introducer. See text for details. © 2018 The Association of Anaesthetists of Great Britain and Ireland 1033 Correspondence Anaesthesia 2018, 73, 1032–1045