Retrospective audit: Use of the laryngeal mask airway in prone patients undergoing elective surgery on the spine - An acceptable alternative?

Since its introduction in the U.K. in 1988 the laryngeal mask airway has undergone repeated refinement. Thanks to its ease of insertion and reduced potential for trauma, in numerous elective procedure it is now established as a safe and sometimes even more effective alternative to ET intubation. Reported cumulative experience confirms its feasibility and safety in the prone patient in the elective setting. Apart from airway rescue manoeuvres, however, its application in the prone patient is very restricted. Reported advantages include patient self-positioning, no need of muscle relaxants and shorter procedures, which would be of advantage in busy operating theatres. We present a retrospective audit of 215 consecutive adult patients scheduled for elective surgery on the lumbar spine. 27 patients with particular physical problems themselves adopted an optimally comfortable prone position. Anaesthesia was then induced, and an appropriate-sized LMA Supreme (TM) or igel (TM) inserted. Patients undergoing surgery in the "tuck position" were positioned after induction. Our results support current literature reports that both devices are useful alternatives for airway management in patients in the prone position. Since it can be very useful in emergency situations or unintentional extubations, its use should be practiced under controlled conditions under which direct laryngoscopy is not feasible. Prospective studies in a large cohort of patients could be helpful for objectifying the apparent advantages and potential risks.