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The laryngeal mask airway: its features, effects and role

Canadian Journal of Anaesthesia volume 41, pages 930–960 (1994)Cite this article

Abstract

The laryngeal mask airway was designed as a new concept in airway management and has been gaining a firm position in anaesthetic practice. Numerous articles and letters about the device have been published in the last decade, but few large controlled trials have been performed. Despite widespread use, the definitive role of the laryngeal mask has yet to be established. In some situations, such as after failed tracheal intubation or in anaesthesia for patients undergoing laparoscopic or oral surgery, its use is controversial. There are a number of unresolved issues, for example the effect of the laryngeal mask on regurgitation and whether or not cricoid pressure prevents placement of the mask. We review the techniques of insertion, details of misplacement, and complications associated with the use of the laryngeal mask. We discuss the features and physiological effects of the device, including the changes in intra-cuff pressure during anaesthesia and effects on blood pressure, heart rate and intra-ocular pressure. We then attempt to clarify the role of the laryngeal mask in airway management during anaesthesia, based on the current knowledge, by discussing the advantages and disadvantages as well as the indications and contraindications of its use. Lastly we describe the use of the laryngeal mask in circumstances other than airway maintenance during anaesthesia: fibreoptic bronchoscopy, tracheal intubation through the mask and its use in cardiopulmonary resuscitation.

Résumé

Le masque laryngé représente un nouvel instrument de contrôle des voies aériennes maintenant solidement établi en anesthésie. De nombreux articles et lettres ont été publiés au cours de la dernière décennie mais peu d’essais cliniques contrôlés ont été réalisés. Malgré son utilisation répandue, on n’a pas encore réussi à attribuer un rôle définitif au masque laryngé. Dans certaines situations, comme après l’intubation ratée ou pour les laparoscopies et la chirurgie buccale, son utilisation est contestée. On dénombre un certain nombre de questions non résolues, par exemple l’effet du masque laryngé sur la régurgitation ou son insertion pendant la pression cricoïdienne. Nous réexaminons les techniques d’introduction, les vices d’insertion et les complications associées à son usage. Nous discutons ses caractéristiques et les répercussions physiologiques de son utilisation, incluant les changements de la pression interne du manchon et ses effets sur la pression artérielle, la fréquence cardiaque et la pression intra-oculaire. Nous tentons ensuite d’élucider le rôle du masque laryngé dans le contrôle des voies aériennes pendant l’anesthésie sur la base des connaissances actuelles par la discussion de ses avantages et désavantages ainsi que ses indications et contre-indications. Pour finir, nous décrivons son utilisation pour d’autres motifs que le maintien des voies aériennes pendant l’anesthésie: la bronchoscopie fibroptique, l’intubation de la trachée à travers le masque et son utilisation en réanimation cardiorespiratoire.

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Affiliations

  1. Department of Anesthesiology, Kansai Medical University, 1 Fumizono-cho, Moriguchi City, 570, Osaka, Japan

    Takashi Asai & Stephen Morris

  2. Department of Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine, CF4 4XN, Heath Park, Cardiff, UK

    Takashi Asai & Stephen Morris

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  1. Takashi Asai
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Asai, T., Morris, S. The laryngeal mask airway: its features, effects and role. Can J Anaesth 41, 930–960 (1994). https://doi.org/10.1007/BF03010937

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Key words

  • anaesthetic techniques: intubation
  • complications: aspiration, difficult intubation
  • equipment: fibreoptic bronchoscope, laryngeal mask airway
  • heart: cardiopulmonary resuscitation
  • intubation, tracheal: technique