To the Editor:-We read with interest the article by Greenberg et al., [1]demonstrating equivalent clinical use of the cuffed oropharyngeal airway (COPA) and the laryngeal mask airway (LMA). However, we are now confused to find that the two coauthors of this article, Drs. Brimacombe and Berry, reported contradictory results elsewhere (i.e., the COPA is inferior to the LMA) only a few months later. [2]The latter investigation was conducted at the same two Australian institutions where more than two thirds of the patients in the article by Greenberg et al. were also studied. These contradictory reports have led us to suspect that the difficulties with the COPA reported by Greenberg et al. occurred predominantly at the two Australian institutions, whereas this device worked well at Johns Hopkins, where the remainder of the patients were studied. Greenberg et al. report “adverse events” on a hospital-by-hospital basis, they but do not present institution-specific results of their measurements. Such information would help resolve this issue.

These discrepancies between studies involving the same authors is obviously worrisome. Furthermore, if the results of Greenberg et al. contain such interinstitutional discrepancies, the obvious question is why? Dr. Greenberg notes that he refrained from personal involvement in patient care at Johns Hopkins. Were Drs. Brimacombe and Berry similarly uninvolved in their institutions, and is it possible that such differing physician involvement and supervision may play some role in the different results?

We look forward to the authors' response.

Takahisa Goto, M.D.

Shoichi Uezono, M.D.

Department of Anesthesia; Teikyo University Ichihara Hospital; 3426-3 Anesaki; Ichihara-shi, Chiba; 299-0111, Japan;

(Accepted for publication December 14, 1998.)

Greenberg RS, Brimacombe J, Berry A, Gouze V, Piantadosi S, Dake EM: A randomized controlled trial comparing the cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anesthetized adults. Anesthesiology 1998; 88:970-7
Brimacombe JR, Brimacombe JC, Berry AM, Morris R, Mecklem D, Clarke G, Barry J, Kirk T: A comparison of the laryngeal mask airway and cuffed oropharyngeal airway in anesthetized adult patients. Anesth Analg 1998; 87:147-52