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Can the laryngeal mask airway be used to give surfactant in preterm infants?
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  • Published on: 22 June 2021
    Surfactant administration via laryngeal mask in preterm infants: a word of caution
    • Daniele Trevisanuto, Neonatologist Department of Woman and Child’s Health, University Hospital of Padova, Padova, Italy
    • Other Contributors:
      • Matteo Parotto, Anesthesiologist
      • Massimo Micaglio, Anesthesiologist

    We read with interest Dr. Smee et al.’s article on surfactant administration via laryngeal mask (LMA) in infants with respiratory distress syndrome: an intriguing topic, suggesting a minimally invasive approach to ensure a well-established therapy.
    The authors stated that “use of LMA to administer surfactant is feasible in infants ≥ 1200g, reducing the need for intubation and mechanical ventilation”. (1) Despite a recent meta-analysis showing that this approach may have some advantages on short term outcomes, (i.e. reduction in need for intubation and mechanical ventilation), available evidence was based on small, poor-quality studies. (2)
    In addition, there are many unanswered questions on the application of this approach in neonates. It is not known which supraglottic airway device (SAD) may be best suited (there are at least 7 different types of commercially available size-1 SADs), the characteristics of the cuff (inflatable or not-inflatable) and the most appropriate size, (3,4) whether a catheter inside the mask should be used and if yes, where the catheter’s tip should be positioned (proximally or distally), under vision or blindly. There is uncertainty on whether the patient needs mild sedation, general or topical anesthesia, or nothing at all, and around the best mode to support respiratory efforts and potential complications (i.e. hypoxia or bradycardia) during the procedure. (1)
    The authors also reported that “LMAs to fit the more immature infan...

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    Conflict of Interest:
    DT and MM received an honorarium for a research project on laryngeal mask from Chiesi Farmaceutici, Parma, Italy