To the Editor:--Paterson et al. have shown that the laryngeal mask airway (LMA) can be used as an effective method of airway management during neonatal resuscitation [1]as an alternative to bag-and-mask ventilation. [2]The investigators suggest caution in the use of the LMA in neonates beyond the population studied, which did not include neonates who were suffering from congenital oropharyngeal pathology. [1]The current report describes the use of LMA for resuscitation of a newborn with Pierre-Robin syndrome after failure of tracheal intubation and face-mask ventilation.

The newborn was a 5-day-old, 3.2 kg, full-term male with Pierre-Robin syndrome (micrognathia, cleft palate). The anesthesiology team was paged when serious airway obstruction and cyanosis developed that were not relieved by lateral positioning of the baby, traction of the tongue, and face-mask oxygen. Pulse oximetry showed the hemoglobin oxygen saturation (SpO2) to be 40% and the electrocardiogram showed sinus bradycardia (50 beats/min). An oropharyngeal airway was inserted, and ventilation via face mask with 100% Oxygen2resulted in inadequate chest inflation associated with gastric distension. Direct laryngoscopy using different blades (Miller, Oxford) failed to visualize the larynx. A size-1 LMA was inserted easily, and its cuff was inflated with 3 ml of air. Ventilation with a T-piece circuit using 100% Oxygen2resulted in adequate and easy chest inflation without gastric distension. The SpO sub 2 increased to 98%, and the heart rate increased to 120 beats/min. After 5 min, the child started to breath spontaneously, and the LMA was removed.

In neonates with mandibular hypoplasia such as Pierre-Robin syndrome or Treacher-Collins syndrome, the posteriourly protruded tongue may result in airway obstruction. Resuscitation of such babies may be difficult because the micrognathia and the posteriourly protruded tongue can contribute to inadequate face-mask ventilation difficult tracheal intubation. [3,4]The current report shows that the LMA can be used successfully for airway management during resuscitation of neonates with Pierre-Robin syndrome.

Anis Baraka, M.D., F.R.C.A., Professor and Chairman, Department of Anesthesiology, American University of Beirut, Beirut, Lebanon

(Accepted for publication June 6, 1995.)

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Emergency Cardiac Care Committee and Sub-Committees, American Heart Association: Guidelines for cardiopulmonary resuscitation and emergency cardiac care. VII Neonatal resuscitation. JAMA 268:2276-2281, 1992.
Handler SD, Kean TP: Difficult laryngoscopy/intubation: The child with mandibular hypoplasia. Ann Otol Rhinol Laryngol 92:401-404, 1983.
Chadd GD, Crane DL, Phillips RM, Tunell WP: Extubation and reintubation guided by the laryngeal mask airway in a child with the Pierre-Robin syndrome. ANESTHESIOLOGY 76:640-641, 1992.