Skip to main content
SpringerLink
Log in
Book cover

The Difficult Airway pp 113–132Cite as

The Role of the Supraglottic Airway

  • Chapter
  • First Online:

  • 2951 Accesses

Abstract

The supraglottic airway (SGA) is a device designed for upper airway management, serving as a bridge, with respect to invasiveness, between facemask ventilation and endotracheal intubation. Most devices consist of an inflatable silicone or polyvinyl chloride mask and connecting tube. When blindly inserted into the pharynx, it forms a low-pressure seal around the laryngeal inlet. The SGA allows ventilation and oxygenation with less stimulation than laryngoscopy and intubation. The laryngeal mask airway (LMA) is the most commonly used SGA and has the largest body of experience and literature. The LMA was invented by Dr. Archie Brain and became commercially available in the UK in 1988 [1]. Dr. Brain remains involved in its continued development and evolution. The device has allowed for the advancement of anesthetic techniques for ambulatory and other types of surgery. It is particularly useful when intubation is difficult, hazardous, or unsuccessful (see Table 7.1).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Brain AI. The laryngeal mask—a new concept in airway management. Br J Anaesth. 1983;55(8):801–5.

    Article  PubMed  CAS  Google Scholar 

  2. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617–31.

    Article  PubMed  CAS  Google Scholar 

  3. Benumof JL. Laryngeal mask airway. Indications and contraindications. Anesthesiology. 1992;77(5):843–6.

    Article  PubMed  CAS  Google Scholar 

  4. Brain A. Proper technique for insertion of the laryngeal mask. Anesthesiology. 1990;73(5):1053.

    Article  PubMed  CAS  Google Scholar 

  5. Gaitini LA, Vaida SJ, Somri M, Yanovski B, Ben-David B, Hagberg CA. A Randomized controlled trial comparing the ProSeal™ laryngeal mask airway with the laryngeal tube suction in mechanically ventilated patients. Anesthesiology. 2004;101(2):316–20.

    Article  PubMed  Google Scholar 

  6. Brimacombe J, Berry A, Verghese C. The laryngeal mask airway: its uses in anesthesiology. Anesthesiology. 1994;80(3):706.

    Article  PubMed  CAS  Google Scholar 

  7. Seet E, Yousaf F, Gupta S, Subramanyam R, Wong DT, Chung F. Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial. Anesthesiology. 2010;112(3):652–7.

    Article  PubMed  Google Scholar 

  8. Brimacombe J, Berry A. Mallampati classification and laryngeal mask airway insertion. Anaesthesia. 1993;48(4):347.

    Article  PubMed  CAS  Google Scholar 

  9. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 1993;78(3):597–602.

    Article  Google Scholar 

  10. Practice Guidelines for Management of the Difficult Airway. An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98(5):1269–77.

    Article  Google Scholar 

  11. Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology. 1996;84(3):686–99.

    Article  PubMed  CAS  Google Scholar 

  12. Ovassapian A, Glassenberg R, Randel GI, Klock A, Mesnick PS, Klafta JM. The unexpected difficult airway and lingual tonsil hyperplasia: a case series and a review of the literature. Anesthesiology. 2002;97(1):124–32.

    Article  PubMed  Google Scholar 

  13. Asai T, Morris S. The role of the laryngeal mask for failed tracheal intubation in the patient with a “full stomach”. Anesth Analg. 1994;78(4):817–9.

    Article  PubMed  CAS  Google Scholar 

  14. Brimacombe J, Berry A, White A. An algorithm for use of the laryngeal mask airway during failed intubation in the patient with a full stomach. Anesth Analg. 1993;77(2):398–9.

    PubMed  CAS  Google Scholar 

  15. Allison A, McCrory J. Tracheal placement of a gum elastic bougie using the laryngeal mask airway. Anaesthesia. 1990;45(5):419–20.

    Article  PubMed  CAS  Google Scholar 

  16. Lim SL, Tay DHB, Thomas E. A comparison of three types of tracheal tube for use in laryngeal mask assisted blind orotracheal intubation. Anaesthesia. 1994;49(3):255–7.

    Article  PubMed  CAS  Google Scholar 

  17. Benumof JL. Use of the laryngeal mask airway to facilitate fiberscope-aided tracheal intubation. Anesth Analg. 1992;74(2):313–5.

    Article  PubMed  CAS  Google Scholar 

  18. Rabb MF, Minkowitz HS, Hagberg CA. Blind intubation through the laryngeal mask airway for management of the difficult airway in infants. Anesthesiology. 1996;84(6):1510–1.

    Article  PubMed  CAS  Google Scholar 

  19. Asai T. Fiberoptic tracheal intubation through the laryngeal mask in an awake patient with ­cervical spine injury. Anesth Analg. 1993;77(2):404.

    PubMed  CAS  Google Scholar 

  20. Parr M, Baskett GM. The intubating laryngeal mask. Anaesthesia. 1998;53:343.

    Article  PubMed  CAS  Google Scholar 

  21. Gerstein NS, Braude DA, Hung O, Sanders JC, Murphy MF. The Fastrach(TM) intubating laryngeal mask Airway(R): an overview and update. Can J Anaesth. 2010;57(6):588.

    Article  PubMed  Google Scholar 

  22. Brain AI, Verghese C, Addy EV, Kapila A. The intubating laryngeal mask. I: development of a new device for intubation of the trachea. Br J Anaesth. 1997;79(6):699–703.

    Article  PubMed  CAS  Google Scholar 

  23. Ferson DZ, Rosenblatt WH, Johansen MJ, Osborn I, Ovassapian A. Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology. 2001;95(5):1175–81.

    Article  PubMed  CAS  Google Scholar 

  24. Dimitriou V, Iatrou C, Brimacombe J, Voyagis GS. Intubating laryngeal mask airway in lateral position. Anesthes Analg. 2004;99(6):1877; author reply.

    Google Scholar 

  25. Combes X, Le Roux B, Suen P, Dumerat M, Motamed C, Sauvat S, et al. Unanticipated difficult airway in anesthetized patients: prospective validation of a management algorithm. Anesthesiology. 2004;100(5):1146–50.

    Article  PubMed  Google Scholar 

  26. Shung J, Avidan MS, Ing R, Klein DC, Pott L. Awake intubation of the difficult airway with the intubating laryngeal mask airway. Anaesthesia. 1998;53(7):645–9.

    Article  PubMed  CAS  Google Scholar 

  27. Frappier J, Guenoun T, Journois D, Philippe H, Aka E, Cadi P, et al. Airway management using the intubating laryngeal mask airway for the morbidly obese patient. Anesthesh Analg. 2003;96(5):1510–5, table of contents.

    Google Scholar 

  28. Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004;59(7):675–94.

    Article  PubMed  CAS  Google Scholar 

  29. Brimacombe J, Keller C, Kunzel KH, Gaber O, Boehler M, Puhringer F. Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers. Anesth Analg. 2000;91(5):1274–8.

    PubMed  CAS  Google Scholar 

  30. Timmermann A, Russo S, Graf BM. Evaluation of the CTrach—an intubating LMA with integrated fibreoptic system. Br J Anaesth. 2006;96(4):516–21.

    Article  PubMed  CAS  Google Scholar 

  31. Liu EH, Goy RW, Lim Y, Chen FG. Success of tracheal intubation with intubating laryngeal mask airways: a randomized trial of the LMA Fastrach and LMA CTrach. Anesthesiology. 2008;108(4):621–6.

    Article  PubMed  Google Scholar 

  32. Wender R, Goldman AJ. Awake insertion of the fibreoptic intubating LMA CTrach in three morbidly obese patients with potentially difficult airways. Anaesthesia. 2007;62(9):948–51.

    Article  PubMed  CAS  Google Scholar 

  33. Brimacombe J, Keller C. The ProSeal laryngeal mask airway: a randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients. Anesthesiology. 2000;93(1):104–9.

    Article  PubMed  CAS  Google Scholar 

  34. Keller C, Brimacombe J, Kleinsasser A, Loeckinger A. Does the ProSeal laryngeal mask airway prevent aspiration of regurgitated fluid? Anesth Analg. 2000;91(4):1017–20.

    Article  PubMed  CAS  Google Scholar 

  35. Maltby JR, Beriault MT, Watson NC. Use of the laryngeal mask is not contraindicated for laparoscopic cholecystectomy. Anaesthesia. 2001;56(8):799.

    Article  Google Scholar 

  36. Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH. LMA-Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy. Can J Anaesth. 2003;50(1):71–7.

    Article  PubMed  Google Scholar 

  37. Cooper RM. The LMA, laparoscopic surgery and the obese patient—can vs should. Can J Anesth. 2003;50(1):5–10.

    Article  PubMed  Google Scholar 

  38. Baxter S, Brooks A, Cook T. Use of a proseal LMA for maintenance after failed intubation during a modified rapid sequence induction. Anaesthesia. 2003;58(11):1132–3.

    Article  PubMed  CAS  Google Scholar 

  39. Rosenblatt WH. The use of the LMA-ProSeal in airway resuscitation. Anesth Analg. 2003;97(6):1773–5.

    Article  PubMed  Google Scholar 

  40. O’Connor Jr JCJ, Borromeo CJ, Stix MS. Assessing ProSeal laryngeal mask positioning: the suprasternal notch test. Anesth Analg. 2002;94(5):1374–5.

    Article  PubMed  Google Scholar 

  41. Osborn IP, Behringer EC, Cooper RM, Verghese C. Detecting the etiologies of acute airway obstruction associated with the laryngeal mask airway supreme(TM). Anesthesiology. 2009;111(2):451–2. doi:10.1097/ALN.0b013e3181adf285.

    Article  PubMed  Google Scholar 

  42. Brimacombe J, Howath A, Keller C. A more ‘failsafe’ approach to difficult intubation with the gum elastic bougie. Anaesthesia. 2002;57(3):292.

    Article  PubMed  CAS  Google Scholar 

  43. Brimacombe J, Keller C. Aspiration of gastric contents during use of a ProSealTM laryngeal mask airway secondary to unidentified foldover malposition. Anesth Analg. 2003;97(4):1192–4.

    Article  PubMed  Google Scholar 

  44. Verghese C, Ramaswamy B. LMA-Supreme—a new single-use LMA with gastric access: a report on its clinical efficacy. Br J Anaesth. 2008;101(3):405–10.

    Article  PubMed  CAS  Google Scholar 

  45. Tan BH, Chen EG, Liu EH. An evaluation of the laryngeal mask airway supreme’ in 100 patients. Anaesth Intensive Care. 2010;38(3):550–4.

    PubMed  CAS  Google Scholar 

  46. Seet E, Rajeev S, Firoz T, Yousaf F, Wong J, Wong DT, et al. Safety and efficacy of laryngeal mask airway Supreme versus laryngeal mask airway ProSeal: a randomized controlled trial. Eur J Anaesthesiol. 2010;27(7):602–7.

    Article  PubMed  Google Scholar 

  47. Abdi W, Dhonneur G, Amathieu R, Adhoum A, Kamoun W, Slavov V, et al. LMA supreme versus facemask ventilation performed by novices: a comparative study in morbidly obese patients showing difficult ventilation predictors. Obes Surg. 2009;19(12):1624–30.

    Article  PubMed  Google Scholar 

  48. Lopez AM, Valero R, Brimacombe J. Insertion and use of the LMA Supreme in the prone position. Anaesthesia. 2010;65(2):154–7.

    Article  PubMed  CAS  Google Scholar 

  49. Bogdanov A, Kapila A. Aintree intubating bougie. Anesth Analg. 2004;98(5):1502.

    Article  PubMed  CAS  Google Scholar 

  50. Blair EJ, Mihai R, Cook TM. Tracheal intubation via the classic and proseal laryngeal mask airways: a manikin study using the aintree intubating catheter. Anaesthesia. 2007;62(4):385–7.

    Article  PubMed  CAS  Google Scholar 

  51. Micaglio M, Ori C, Parotto M, Feltracco P. Three different approaches to fibreoptic-guided intubation via the Laryngeal Mask Airway Supreme. J Clin Anesth. 2009;21(2):153–4.

    Article  PubMed  Google Scholar 

  52. Woodall N, Frerk C, Cook TM. Can we make airway management (even) safer?—lessons from national audit. Anaesthesia. 2011;66 Suppl 2:27–33.

    Article  PubMed  Google Scholar 

  53. Woodall NM, Cook TM. National census of airway management techniques used for anaesthesia in the UK: first phase of the Fourth National Audit Project at the Royal College of Anaesthetists. Br J Anaesth. 2011;106(2):266–71.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Mount Sinai Medical Center, One Gustave L. Levy Place, 1010, New York, NY, 10029, USA

    Irene P. Osborn

Authors
  1. Irene P. Osborn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Irene P. Osborn .

Editor information

Editors and Affiliations

  1. Department of Anesthesia & Critical Care, University of Chicago, Chicago, 60637, Illinois, USA

    David B. Glick

  2. University of Toronto, Department of Anesthesia and Pain Manage, Department of Anesthesia, Toronto General Hospital, Toronto, M5G 2C4, Ontario, Canada

    Richard M Cooper

  3. Department of Anesthesia & Critical Care, University of Chicago, Chicago, 60637, Illinois, USA

    Andranik Ovassapian

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Osborn, I.P. (2013). The Role of the Supraglottic Airway. In: Glick, D., Cooper, R., Ovassapian, A. (eds) The Difficult Airway. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92849-4_7

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-92849-4_7

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92848-7

  • Online ISBN: 978-0-387-92849-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation