Comment on an unidentifiably severed LMA supreme: An unanticipated critical incident

Dear Editor, I read with great interest the publication “An unidentifiably severed laryngeal mask airway (LMA) supreme: An unanticipated critical incident” by Pruthi G et al.[1] Only a few studies have documented such unique breakage, and all have denied any undue pressure from the patient circuit on the LMA.[2,3] I would like to contribute that none of the studies mentioned the dates of manufacturing and expiry. LMAs have a long shelf life, and many LMAs, such as the LMA® ProSeal™, are reused without any breakage or leaks. The LMA supreme, made of polyvinyl chloride, has a shelf life of 5 years and can only be used within a temperature range of −10 to +60°C. High temperatures and low humidity can lead to yellowing and degradation of the LMA. All types of plastic polymers have a degradation (thermo-oxidative) rate that should also be taken into account.[4] Second, the pressure applied during manipulation of the fixation tab should also be considered, but nothing concrete has been documented. Last, in packaging, only the airway cuff is enclosed in a protective hard casing, whereas the entire LMA is covered by a thin paper-plastic cover, which does not provide adequate protection for the rest of the LMA. All components should be thoroughly checked before use. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.