Letters to the Editor: Letters & Announcements
To the Editor:
The laryngeal mask airway (LMA) is now an established tool in neonatal airway management in both elective and emergent scenarios (1,2). We report a case in which a LMA was left in situ for 8 days without adverse sequelae, the longest reported use of a LMA in a neonate.
A 3-wk-old male infant with profound micrognathia presented for ligation of a patent ductus arteriosus. After an inhaled induction of anesthesia, fiberoptic intubation with an endotracheal tube (3.0-mm inner diameter Mallinckrodt) was performed through the LMA (size 1.0 LMA Unique™). Postoperatively the patient was transferred back to the neonatal intensive care unit with the expectation that extubation and removal of the LMA would be performed within the following 24 h. The LMA cuff was deflated. However, the patient's condition deteriorated, necessitating inotropic support and nitric oxide. Eight days later he patient was transferred to the operating room and the LMA was cut from the endotracheal tube. The otolaryngology attending physician examined the patient's oropharynx and found no apparent injury associated with the long-term application of the LMA.
In our literature search we found only 2 case reports of extended-duration LMA placement in the neonatal population. Bucx et al. (3) managed the care of a 10-day old neonate with Treacher Collins syndrome by using the LMA for 4 days with no evidence of pharyngolaryngeal injury. Yao et al. (4) used it in a neonate with Pierre Robin syndrome for 6 days, changing it daily to relieve mucosal pressure. Our case differs from those just cited: the duration was 8 days, the LMA was not exchanged and it was kept fully deflated.
Based on what we learned from the limited scientific literature available and our own experience, we believe long-term LMA use in the neonatal population is a feasible and potentially safe technique for handling complex upper airway management.
Warwick A. Ames, MBBS, FRCA
Stephanie F. Fischer, FCA(SA)
Scott Schulman, MD
Guy De Lisle Dear, MB, FRCA
Division of Pediatric Anesthesia
Duke University Medical Center
Durham, North Carolina
1. Leal-Pavey YR. Use of the LMA classic to secure the airway of a premature neonate with Smith-Lemli-Opitz syndrome: a case report. AANA J 2004;72:427–30.
2. Trevisanuto D, Micaglio M, Ferrarese P, Zanardo V. The laryngeal mask airway: potential applications in neonates. Arch Dis Child Fetal Neonatal Ed 2004;89:F485–9.
3. Bucx MJL, Grolman W, Kruisinga FH, et al. The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndrome. Paediatr Anaesth 2003;13:530–3.
4. Yao CT, Wang JN, Tai YT, et al. Successful management of a neonate with Pierre-Robin syndrome and severe upper airway obstruction by long term placement of a laryngeal mask airway. Resuscitation 2004;61:97–9.