Editor—We read with interest the editorial by van Zundert and colleagues1 in the recent issue of British Journal of Anaesthesia. We strongly commend the authors for highlighting the problem of suboptimal laryngeal mask airway (LMA) placement. As a single specialty ear, nose, and throat hospital, we are perhaps in a unique position in that the majority of our caseload is shared airway using first-generation flexible LMAs. Since the flexible LMA was introduced at our hospital in 1990, we estimate that we have performed >135 000 ENT operations, with 80–85% performed with flexible LMAs. This includes a large number of shared airway procedures, such as tonsillectomy. These procedures, in themselves, are a good test of LMA function, requiring the maintenance of optimal ventilation whilst also protecting the larynx from blood and debris.
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