Case Reports: Letter to the Editor
To the Editor
Mireles et al1 recently described a novel way to secure the laryngeal mask airway (LMA; PROP, Great Lakes Orthodontics, Tonawanda, NY) during oral procedures. But we have a solution to securing the LMA in nonoral surgery procedures. After proper insertion, the LMA is unstable and may flip out of the mouth unless it is secured and taped to a bite block and fixed to the maxilla.2 In patients with beards, LMA fixation could be even more problematic.3 To improve its stability and avoid mask rotation, the manufacturers recommend that the LMA tube be pressed into the palatopharyngeal arch, and that the tube outlet face the patient’s feet. To keep the LMA in this position, a slight downward pressure should be exerted to keep it steady and prevent it from dislodgement. Typically, this is accomplished by extra taping. Our method does not require extra taping; we use the corrugated tubes of the anesthesia circuit to do what extra taping would do, but in a more secure manner. As can be seen in the Figure, we put the inspiratory and expiratory corrugated tubes parallel to each other and along both sides of the patient’s neck. The Y-piece is attached to the LMA tube in such a way that the opening of the connector faces the patient’s forehead. Both corrugated tubes serve as anchors to keep the LMA from dislodgement and rotation. Because of the nature of the corrugated tube, it exerts pressure to stabilize the LMA in place.
Shahram ShokohiMir Mousa AghdashiDepartment of AnesthesiologyEmam Khomeini University HospitalUrmia University of Medical SciencesUrmia, West Azerbaijan, Iranshokohi725@yahoo.com
1. Mireles R, Devgun R, Tucker B, et al.A novel way to secure the laryngeal mask airway during oral surgery procedures. Anesth Analg. 2017;124:1836–1838.
2. Conacher IDA method of fixing laryngeal mask airways. Anaesthesia. 2007;48:638.
3. Bansal T, Jaiswal RAn innovative way of securing laryngeal mask airway in bearded patients..;:.Egypt J Anaesth201430323–324