We report four cases of difficult airway managed with a laryngeal mask airw
ay (LMA) under propofol anaesthesia; this method was chosen to minimize psy
chological and physical trauma. Case 1 was a boy with dermatomyositis; Case
2, a girl wearing a base ring of a stereotactic frame; Case 3, a boy with
Treacher-Collins syndrome; Case 4, a boy with Goldenhar syndrome. They were
anaesthesized with propofol and though spontaneous ventilation became shal
lower, or apnoea occurred, the stimulus of inserting an LMA awakened the pa
tient and caused more active spontaneous ventilation while a patent airway
was established by the LMA. All tracheal intubations were performed smoothl
y and without delay through the LMA, and we believe that psychological and
physical trauma was thus minimized.