In Reply:—

Edwards and Searl have suggested that our article “highlights the failure of the ILMA [intubating laryngeal mask airway]” (Fastrach  ; LMA North America, San Diego, CA). In our opinion, their comments reflect a misunderstanding of the potential role of the ILMA in airway management. The basis for their comment that “there is no advantage afforded by the use of an ILMA in low-risk patients” is unclear. In fact, it could be argued that the ILMA offers significant advantages over the “ordinary laryngeal mask airway” because it is easier to insert, offers the option of tracheal intubation—should the situation arise at a later time during the operation, and is less likely to be inadvertently discarded after the case. It is not clear what is lost by inserting an ILMA rather than an ordinary laryngeal mask airway.

Because we did not study patients with “expected difficult intubation,”1we cannot comment on the authors’ statement that it is more difficult to insert the device in this patient population. However, we have used the ILMA successfully to intubate patients with cervical spine disorders. 2Although it may be more difficult to insert a regular laryngeal mask airway in “expected difficult intubation,” this may or may not be true with the ILMA. Further studies with the ILMA in patients with difficult airways are clearly needed.

Finally, using a small dose of a muscle relaxant to facilitate tracheal intubation with the ILMA does not necessarily negate its potential facilitating tracheal intubation.

van Vlymen JM, Coloma M, Tongier K, White PF: Use of the Intubating Laryngeal Mask Airway: Are muscle relaxants necessary? A nesthesiology 2000; 93: 340–5
Wong JK, Tongier WK, Armbruster SC, White PF: Use of the intubating laryngeal mask airway to facilitate awake orotracheal intubation in patients with cervical spine disorders. J Clin Anesth 1999; 11: 346–8