Oxygen insufflation at 10–15 L/min using our described technique is highly unlikely to cause gastric insufflation. Firstly, oxygen insufflation at the entrance of the proximal end of the SAD ventilation port can be considered to be in an open circuit. Any buildup of pressure would dissipate quickly via the path of least resistance (retrograde to the atmosphere) rather than moving anterograde through the ventilation port occupied by the bronchoscope. Secondly, 50 L/min of high-flow nasal oxygen only achieves a mean airway pressure of up to 7 cmH₂O [2], which would not overcome a resting lower esophageal sphincter pressure of 15–35 mmHg (20–47 cmH₂O) [3] to cause gastric insufflation. Awake insertion of SADs does not alter the gastroesophageal barrier pressure [4]. The following two studies evaluating gastric insufflation with antral ultrasonography also supported a low risk of gastric insufflation. First, face mask ventilation at 10 cmH₂O under anesthesia without neuromuscular blockade showed that gastric insufflation occurred in 0% of cases [5]. Second, all 30 fasted patients who were administered with high-flow nasal oxygen at 70 L/min for a total of 30 min had grade 0 or 1 antrum scores, consistent with fasting. Moreover, in the sitting position, the stomach is lower in relation to the glottis; therefore, the risk of regurgitation and aspiration is potentially reduced.