Reply to comments on “Comparative analysis of LMA Blockbuster® clinical performance: Blind versus Miller laryngoscope-guided insertion in paediatric general anaesthesia – A double-blinded, randomised controlled trial”

Dear Editor, We appreciate the readers for their constructive feedback, which contributes to a more nuanced understanding of laryngeal mask airway (LMA) Blockbuster® performance in paediatric anaesthesia.[1,2] Epiglottic downfolding is a common cause of LMA malposition.[3] Lifting the epiglottis with the Miller laryngoscope helps prevent this. While video laryngoscopy (VL) or ultrasound has advantages, it is not universally available, and curved blades of VL occupy more space in the oral cavity.[4] Our study focused on evaluating LMA Blockbuster® positioning at the glottic level. We did not specifically evaluate the ease of insertion of an orogastric tube; however, we did not observe any difficulty inserting a suction catheter, which was performed per the protocol for all patients. We used a uniform intracuff pressure of 60 cm H2O; the literature also suggests keeping intracuff pressure up to 60 cm H2O in paediatric patients.[5,6] Sometimes, the gastric channel may downfold, obstructing the correct placement of the device; thus, we proceeded with intubation if three insertion attempts failed. We applied a small amount of 2% lignocaine jelly on the cuff. Ideally, a water-based lubricant should be used when available; however, lignocaine jelly can be used as it has been shown not to increase aspiration risk while effectively reducing the incidence of postoperative sore throat.[7] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.