We Thank Drs Patel and Turner for Providing New Audit Data Anaphylaxis and Anaesthesia

about the prevention of aspiration. Frankly, we were astonished to see that nobody in the Belfast City Hospital admitted to preferring the LMA in obese patients, as there is a substantial body of knowledge supporting its use in this situation. Perhaps more than anything, however, these new data illustrate the wide variation in clinical practice among institutes. In Cairns Private Hospital, for instance, where one of us works, more than 90% of patients undergoing laparoscopic surgery, or who are obese, or who have had reflux, are managed with the ProSeal LMA. We agree that aspiration with the LMA is under-reported and that a confidential database should be created; however, this database should cover all airway devices, as the majority of aspiration events is associated with non-LMA devices, and it is only by comparing the frequency of aspiration among different airway devices in specific clinical situations that we can begin to determine best clinical practice.