LAUSR

The Laryngeal Mask Airway (LMA) ProtectorTM (Teleflex Medical, Co. Westmeath, Ireland) is the newest second generation LMA. It has several differences compared to the former model of LMA LMA Supreme. The LMA Protector is made with silicone, which allows gentle insertion, in contrast to LMA Supreme that is made with polyvinyl chloride. In addition, the LMA Protector has a cuff pressure indicator for continuous pressure monitoring [1]. The “fold-over malposition” is common during the insertion of a LMA that does not have a back plate [2]. The reinforced tip for preventing insertion failure due to folding over is one of the key features of the LMA Protector and LMA Supreme. The hard tip helps prevent folding over of the LMA, but paradoxically, the tip sometimes folds back in the opposite direction and leads to insertion failure and malposition. Additionally, the reinforced distal tip is 18mm in the LMA Protector, whereas the tip is 11mm in the LMA Supreme (Fig. 1, measurements were made using a Mitutoyo 530-108 Vanier Micrometer Caliper [Mitutoyo Corporation, Kawasaki, Japan]). The relatively thick tip of the LMA Protector is due to the opening of the endotracheal tube. During insertion, a desufflated silicone seal cannot disperse the pressure against the solid tip, which leads to tip folding. Digital intraoral manipulation and repetitive attempts are frequently required in the insertion of the LMA Protector. The repetitive insertion attempts are closely related to complications such as sore throat or bleeding. Thermosoftening is one of the methods for minimizing airway injury caused by the insertion of a nasotracheal tube or a double-lumen endobronchial tube [3,4]. We applied thermosoftening to the LMA Protector in order to avoid multiple insertion attempts and distal intraoral manipulation. Written informed consent for all procedures and