Their reasoning focuses on the theoretical risk of increased pharyngeal morbidity and regurgitation. However, procedures frequently take longer than predicted and the question arises as to whether the LMA should be removed and the trachea intubated if anaesthesia extends beyond two hours. We would like to present data from 15 patients who underwent planned prolonged anaesthesia which suggests that in the hands of experienced personnel the technique is safe for some procedures of 4--8 hr duration. All patients were ASA 1-3 and underwent lower limb orthopaedic or plastic surgery. A balanced regional technique was utilised as previously described.2 The mean (range) for age, weight and procedure duration was 36 (18-52) yr, 81 (57-92) kg and 4.6 (4.1-7.8) hrs. All LMA insertions were successful at the first attempt with a median fibreoptic score of 3.3. The SpO2 remained >95% and PE'rCO2 ranged from 34 to 68 mmHg. In four patients, thoraeo-abdominal movement was monitored with two extensometers 2 and there was no evidence of respiratory fatigue. There was also no evidence of positional instability of the LMA cuff or regurgitation. Three patients developed a mild sore throat, but there were no other adverse sequelae. These data lend further support to the concept that prolonged LMA usage is safe 2,3 and suggests that there is no need to exchange the LMA for a tracheal tube if surgery unexpectedly exceeds two hours. The LMA in intracranial aneurysm surgeryTo the Editor:The anaesthetic management of intracranial aneurysms is a trade-off in avoiding hypertension to prevent aneurysmal rerupture t and hypotension to prevent aggravation of pre-existing cerebral ischaemia due to vasospasm. 2-4 There are several advantages of the laryngeal mask air-CAN J ANAESTH 1995 / 42:12 / pp 1176--9

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