The laryngeal mask for intraocular surgery.

CORRESPONDENCE THE LARYNGEAL MASK FOR INTRAOCULAR SURGERY Sir,—Ripart, Cohendy and Eledjam [1], in commenting upon the article by Lamb, James and Janicki [2], described two untoward incidents associated with the use of the laryngcal mask airway (LMA) for controlled ventilation during intraocular surgery. As a result, they have abandoned the technique. They have done so without relating the incidents to their total experience of the LMA and without quantifying the complications associated with tracheal intubation. Our own clinical experience of LMA use with controlled ventilation in intraocular surgery during the past 2 years supports the original contentions of Lamb, James and Janicki [2]. Our audit data show that, in 593 uses, there were six difficult placements (five were eventually successful, while in the sixth the trachea was subsequently intubatcd); one LMA became displaced during the procedure but was repositioned quickly and successfully and there was one case of gastric distension because of malplacement which was corrected before surgery commenced. Only the last two incidents presented a significant clinical problem (0.3% of the total use). Neither resulted in morbidity. Over the same period this compared with a 1.6 % incidence of serious problems with the use of tracheal tubes (three of 187 uses): one case of laryngeal spasm, one difficult intubation and one episode of pulmonary oedema at extubation. For all our surgical specialties, 135 incidents were reported in 3974 tracheal intubations (3.4%): 120 difficult placements and 15 episodes of laryngeal spasm. There were 52 incidents in 5655 LMA uses (0.9%): 45 difficult placements and seven episodes of laryngeal spasm (chi-square = 73.93; P < 0.001). With sufficient experience, use of the LMA can provide improved operating conditions for intraocular surgery and a smooth recovery with a small incidence of serious problems. Contrary to the anecdotal comments of Ripart, Cohendy and Eledjam, our data support use of the LMA for controlled ventilation in intraocular surgery. The Laryngeal mask airway for intraocular surgery: effect on intraocular pressure and stress responses. Sir,—Ripart, Cohendy and Eledjam [1] described two cases of LMA displacement associated with use in paralysed patients undergoing artificial ventilation for intraocular surgical procedures. These cases serve to illustrate the dangers of incomplete understanding of how to use this deceptively simple instrument. Because of its anatomical position, the LMA provides a leak-free seal permitting positive pressure ventilation, provided that: (1) The laryngeal muscles, including the vocal cords, remain sufficiently relaxed throughout the …