Time Required to Insert Laryngeal Mask Airway in Neonates Requiring Resuscitation

Scott J. Paterson, M.D., Resident, Department of Anaesthesia.Paul J. Byrne, F.R.C.P.C., Associate Professor, Department of Paediatrics.Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2B7.To the Editor:—We appreciate the comments by Robotham in the accompanying Highlight to our recent publication. [1] We were pleased with his evaluation that our study was clinically relevant with the potential to ultimately influence clinical management after a more extensive evaluation of the laryngeal mask airway (LMA) in the resuscitation of neonates.At our institution, a large-scale prospective randomized application of this technique is underway to compare the LMA to bag-and-mask ventilation during neonatal resuscitation. We anticipate publication of the results following this more extensive evaluation.However, Robotham has incorrectly stated the average time for placement of the LMA was 30 s. We feel this error must be addressed as it significantly differs from the reported value and misrepresents our results. In fact, the Materials and Methods describes that, if the LMA could not be successfully inserted and effective ventilation established within 20 s, it was to be removed. Our results reported the LMA was easy to insert with one attempt and provided a clinically patent airway in all cases. The time for insertion and establishment of effective ventilation, as displayed in Table 2, was a mean (plus/minus SD) of 8.6 plus/minus 1.4 s (range 7–12 s).The time to insert the LMA and establish effective ventilation may be longer or shorter than the time needed to establish effective ventilation with a bag-and-mask. The answer to this question and the clinical significance should be resolved after our current randomized trial of using the bag-and-mask versus the LMA for neonatal resuscitation.Scott J. Paterson, M.D., Resident, Department of Anaesthesia.Paul J. Byrne, F.R.C.P.C., Associate Professor, Department of Paediatrics.Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2B7.(Accepted for publication October 6, 1994.)