Proposed Standardizations for the LMA

Danielle M. Reicher, MD

To the Editor:

I applaud the excellent work and publications of the APSF, and I thank you for the outstanding Newsletter.

I would like to make an appeal to all the LMA manufacturers. As an anesthesiologist in practice for the last 26 years, I celebrate the innovation that is the LMA. This remarkable device has revolutionized anesthesia care and our entire practice. As more and more companies enter the market in this arena, we see a multitude of LMAs designed for various special uses. There are 2 safety issues of great concern to me. The first issue is that of the intrinsic bite block. It is my belief that all LMAs should share this feature to avoid occlusion of the LMA if the patient bites down during emergence.

The second and more serious issue is that of intubation via an LMA. It is my belief that all LMAs, not just the “intubating LMAs” should easily accommodate an endotracheal tube. This would simply require that all LMAs have a slightly shorter shaft and larger lumen. I don’t believe this would impair the use of specific LMAs in any way, and it would prevent the need for changing LMAs in an urgent airway situation.

Just as we have standard adapters on endotracheal tubes and standardized luer lock syringes, we deserve a standardized LMA design that would facilitate endotracheal intubation in emergencies.

Perhaps the APSF can assist in advocating for this standard.

Danielle M. Reicher, MD
Encinitas, CA