LAUSR

vasive upper gastrointestinal (GI) endoscopy, the need for deep sedation or general anesthesia (GA) during these procedures has grown rapidly. Therefore, the ability to secure the airway while allowing an easy endoscopic access has also become more relevant. Sedation during esophagogastroduodenoscopy (EGD) is not risk-free. Deep sedation can occasionally turn into GA, particularly when propofol is used [1]. Sometimes, deeply sedated patients may also have patient state index levels associated with GA. Deep sedation can potentially risk airway and respiratory compromise [1]. In a retrospective analysis of 73,029 GI endoscopies, 72% of the peri-procedural cardiac arrests were associated with airway management [2]. The laryngeal mask airway (LMA) LMA Gastro Airway (Teleflex Medical, Ireland) is a cuffed peri-laryngeal supra-glottic airway (SGA) with an endoscopic channel, having a maximum outer diameter of 14 mm, which suits all standard endoscopes. Its design features include a channel for esophageal intubation, a separate channel with a terminal cuff for lung ventilation, and an integrated bite block and cuff pressure indicator. It comes in three available sizes: #3 (30–50 kg), #4 (50–70 kg), and #5 (70–100 kg). In a recent prospective observational study, Terblanche et al. showed that LMA Gastro had an airway insertion success rate of 99% and a first-attempt endoscopy success rate of 93% in 292 patients with low risk of pulmonary aspiration. The median lowest intraoperative oxygen saturation was 98% [3]. We describe our experiences with the use of LMA Gastro Airway in two patients undergoing upper GI endoscopy. Both patients provided written informed consent for the publication of this study. In both cases, a suitably sized LMA Gastro was inserted after the standard routine general anesthesia protocol, and GA was maintained using volatile agents. Case 1 was that of a 65-year-old Chinese man (height, 175 cm; weight, 58.9 kg; body mass index, 19.23 kg/m) with a history of hypertension and recurrent esophageal cancer with previous Ivor Lewis esophagogastrectomy. He underwent EGD and stenting of the recurrent esophageal cancer under GA using LMA Gastro #4 inserted successfully in the first attempt after induction by a senior anesthesiologist (Fig. 1). Subsequently, Letter to the Editor