Response to: ‘Failed supraglottic airway’: an algorithm for suboptimally placed supraglottic airway devices based on videolaryngoscopy

Editor—We read with interest the editorial by van Zundert and colleagues¹ in the recent issue of British Journal of Anaesthesia. We strongly commend the authors for highlighting the problem of suboptimal laryngeal mask airway (LMA) placement. As a single specialty ear, nose, and throat hospital, we are perhaps in a unique position in that the majority of our caseload is shared airway using first-generation flexible LMAs. Since the flexible LMA was introduced at our hospital in 1990, we estimate that we have performed >135 000 ENT operations, with 80–85% performed with flexible LMAs. This includes a large number of shared airway procedures, such as tonsillectomy. These procedures, in themselves, are a good test of LMA function, requiring the maintenance of optimal ventilation whilst also protecting the larynx from blood and debris.

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