RevBrasAnestesiol.2014;64(1):71
REVISTA
BRASILEIRA
DE
ANESTESIOLOGIA
OfficialPublicationoftheBrazilianSocietyofAnesthesiology www.sba.com.brLETTER
TO
THE
EDITOR
The
use
of
laryngeal
mask
airway
in
tonsillectomies
Ireadthe articlewritten by RanieriJunior etal.1 inyour
journal and aggree with the authors’ take. The use of a
laryngeal maskairwayin adenotonsillectomiesispossible;
however,thetrachealtubeissafercomparedtothe
laryn-gealmask.Inrecentpublications,theuseofLMAisreported
superiortoendotrachealentubationatadenotonsillectomy
operations.2,3 I believe that LMA use for pediatric
tonsil-lectomy and adenoidectomy is associated with a higher
incidenceofcomplications.IconsidertheLMAtonsillectomy
technique important to use. Previously published studies
have rarely reportedthe importance ofthe tonsillectomy
technique. Cold tonsillectomy bleeding rates are greater
thaninthe hottonsillectomytechniques (bipolar,thermal
welding,coblation,laser).4Inthecold technique,theuse
ofLMAcanleadtobloodaspiration;bleedingcontrolisquite
difficultifthesuturesareusedinthetonsillarfossa.
Further-more,placementofLMAinthemouthofyoungerchildren,
andgrade 4hypertrophy oftonsilsdonot provideenough
surgicalvisualization.Thus,Iwouldnotsuggesttheuseof
LMAintonsillectomy,exceptinspecificcases.
References
1.Ranieri Junior D, Neubauer AG, Ranieri DM, do Nasci-mento Junior P. The use of disposable laryngeal mask airwayforadenotonsillectomies.RevBrasAnestesiol.2012;62: 788---98.
2.SierpinaDI,ChaudharyH,WalnerDL,etal.Laryngealmask air-wayversusendotrachealtube inpediatricadenotonsillectomy. Laryngoscope.2012;122:429---35.
3.Peng A, Dodson KM, Thacker LR, Kierce J, Shapiro J, BaldassariCM.Useoflaryngeal maskairway inpediatric ade-notonsillectomy. Arch Otolaryngol Head Neck Surg. 2011;137: 42---6.
4.Ozkiris¸ M, Kapusuz Z, Saydam L. Comparison of three tech-niques in pediatric tonsillectomy. Eur Arch Otorhinolaryngol. 2012;269:1497---501.
AlperNabiErkan
DepartmentofOtorhinolaryngology,BaskentUniversity, Ankara,Turkey
E-mail:alpernabierkan@yahoo.com,
anerkan@baskent.edu.tr
0104-0014/$–seefrontmatter©2013SociedadeBrasileiradeAnestesiologia.PublishedbyElsevierEditoraLtda.Allrightsreserved.
RevBrasAnestesiol.2014;64(1):72
REVISTA
BRASILEIRA
DE
ANESTESIOLOGIA
OfficialPublicationoftheBrazilianSocietyofAnesthesiology www.sba.com.brLETTER
TO
THE
EDITOR
Reply
to
Alper
Nabi
Erkan
Iappreciate Prof. Erkan’s commentsregarding my recent article-Theuseofdisposablelaryngealmaskairway(LMA) for adenotonsillectomies1 - with particular emphasis on
patientsafety.
Recent publications show the LMA’s superiority over
tracheal tube considering respiratory complications in
adenotonsillectomies.2,3 In my study, I did not use the
enforced spiral LMA and there were no statistically
dif-ferencesinrespiratorycomplications betweenthegroups.
Nonetheless,itwasnecessarytoexchangethreepatients’
LMAforanendotrachealtubeduetogasleakingwith
cervi-calhyperextensionforsurgery.Anotherpatienthadvalues
ofoxygensaturationdownto58%aftergastricregurgitation
andatrachealtubehadtobeinserted.
Thus,inpatientswithhypertrophiedtonsils,sometimes
thelaryngoscopehastobeusedtocorrectLMApositioning
oreventoreplaceitbyatrachealtube.
Consideringthesurgicalapproachandtechnique,theuse
of sutures and especially hot techniques may be related
tootherpostoperativecomplicationsandpain.4Auniform
surgicaltechnique,includingtheuseofbismuthsubgallate
andreassessmentofthetonsillar fossaebeforetakingout
DOIoforiginalarticle:
http://dx.doi.org/10.1016/j.bjane.2013.11.001
the respiratory device, reduces the incidence of primary
tonsillar hemorrhage. Despite this fact, according to my
experienceandresearch,IagreewithDr.Erkananddonot
encouragetheuseofLMAfortonsillectomies.
References
1.RanieriJr D,NeubauerAG,Ranieri MD,Nascimento Jr P.The useofdisposablemaskairwayforadenotonsillectomies.RevBras Anestesiol.2012;62:788---92.
2.KretzFJ,ReimannB,StelznerJ,etal.Thelaryngealmaskin pedi-atricadenotonsillectomy.Themeta-analysisofmedicalstudies Anaesthesist.2000;49:706---12.
3.GravningsbratenR,NicklassonB,RaederJ.Safetyoflaryngeal maskairwayandshort-staypracticeinoffice-based adenotonsil-lectomy.ActaAnaesthesiolScand.2009;53:218---22.
4.PinderDK,WilsonH,HiltonMP.Dissectionversusdiathermyfor tonsillectomy.CochraneDatabaseSystRev.2011;3:CD002211.
DanteRanieriJunior
HospitaldoCorac¸ãodeBalneárioCamboriú,SC,Brazil;
HospitalUnimedLitoral,Itajaí,SC,Brazil
E-mail:deranieri@terra.com.br
0104-0014/$–seefrontmatter©2013SociedadeBrasileiradeAnestesiologia.PublishedbyElsevierEditoraLtda.Allrightsreserved.
