Laparoscopy and the laryngeal mask airway.

circulating cortisol concentration was found during surgery with the combined technique as retrobulbar block had denervated the eye. Our conclusion was not that retrobulbar block failed to prevent a stress response; indeed it obviously does block the endocrine and metabolic response to cataract surgery. The major finding was that, despite an obviously adequate retrobulbar block preventing the stress response to surgery, on waking from anaesthesia, an increase in cortisol concentration occurred in a pain-free patient. Local analgesia prevents the cortisol and glycaemic responses to cataract surgery. Plasma catecholamine response to cataract surgery: a comparison between general and local anaesthesia. Sir,—I read with interest the study by Malins and colleagues on postoperative nausea and vomiting after gynaecological lapar-oscopy [1]. Co-incidentally, the standard anaesthetic technique involved ventilation via the laryngeal mask airway (LMA) and in their discussion the authors correctly observed that this technique is controversial [2, 3], even though current trials suggest it is safe [4, 5]. Composite data from previously published literature reveal that die LMA has been used in only 300 patients undergoing gynaecological laparoscopy [4-8], none of whom apparently aspirated or had difficulties with gas exchange. The 153 patients studied by Malins and colleagues therefore represent a large proportion of published data and it would be useful if the authors could provide further details about how much Trendelenburg tilt was used, what levels of intra-abdominal pressure were produced and whether or not there were any problems with the technique. Finally, the authors state that some of them have been using the LMA for gynaecological laparoscopy for 5 yr without any clinical problems. An indication of the total number of patients involved would add further perspective to this controversy. 1. Malins AF, Field JM, Nesling PM, Cooper GM. Nausea and vomiting after gynaecological laparoscopy: comparison of premedication with oral andansetron, metoclopramide and placebo. Day case laparoscopy —a comparison of two anaesthetic techniques using the laryngeal mask during spontaneous breathing. The laryngeal mask for elective gynecologic surgery: A very attractive oral airway dispositive. Sir,—The obvious clinical benefits in the early recovery phase persuaded us to pursue the technique of controlled ventilation using a laryngeal mask airway (LMA) for day-case laparoscopy, in selected cases. From the outset, in our clinical practice, we considered the potential risks of aspiration, excluding its use in women with a history of gastro-oesophageal reflux, obvious obesity or when prolonged Trendelenburg position was anticipated. During initial clinical …