Mechanical closure of the vocal cords with the Airway Management Device.

EditorÐWe were interested to read O'Neil's correspondence in reference to the case report by Brimacombe and colleagues. Brimacombe and colleagues claim that the Airway Management Device (AMDÔ) cannot cause cord closure and still form an effective seal in the hypopharynx. We would like to share our experience in using the recently introduced AMDÔ that has design modi®cations claimed to prevent glottic compression. Insertion of the AMDÔ is easy and relatively atraumatic, but airway obstruction was quite common using the original device. 5 The failures reported were 11 and 29%. Our experience with the newly modi®ed AMDÔ is not very different from that with the original AMDÔ, as we encountered a 20% incidence of airway obstruction. We cannot comment on the reason for the airway obstruction, as ®breoptic examination was not performed. We hypothesize that it may be due to epiglottic down folding or mechanical cord closure as suggested by Brimacombe and colleagues. An interesting observation from our recently concluded study is the difference in the incidence of obstruction between the sexes. We had a 6% incidence of airway obstruction in females where a size 3 AMDÔ was used, compared with 33% in males where sizes 4 and 5 were used. Even though the AMDÔ was redesigned to reduce the incidence of airway obstruction, our recent study suggests that this is still a common problem with the AMDÔ, particularly in the male population.