Oropharyngeal and nasopharyngeal airways: I (1880–1995)

Abstract

Purpose

During the past decade the laryngeal mask airway (LMA) has dominated literature about airways for use during general anaesthesia. The LMA addresses clearly defined clinical objectives. The purpose of this study is to determine whether those objectives were described collectively with reference to earlier airway designs.

Methods

The anaesthesia sections of Index Medicus 1880–1995 were read and publications in the English language about airways were obtained and analysed. Secondary information sources were references to causes of respiratory obstruction. This was supplemented by random reference to available textbooks.

Results

The multiple objectives, as least partially, satisfied by the LMA were not described collectively at the time of Hewitt’s presentation of an oropharyngeal airway in 1908 and largely were neglected until the present time.

Conclusion

The design of airways has been based on clinical circumstances and perceived requirements of the time. In contemporary anaesthetic practice, distinct clinical situations still occur and there is a role for different device designs. Currently for supraglottic airway management during general anaesthesia, four types of airway should be available: a Guedel airway, nasopharyngeal airway, a laryngeal mask airway, and an airway specifically designed to facilitate blind tracheal intubation.

Résumé

Objectif

Au cours de la dernière décennie, les publications sur les dispositifs de contrôle des voies aériennes pendant l’anesthésie générale ont surtout porté sur le masque laryngé (ML). Le ML visait manifestement des objectifs cliniques définis. Le but de cette étude était de vérifier la conformité de l’ensemble des ces objectifs avec les concepts antérieurs.

Méthodes

Les sections de l’Index Medicus de 1880 à 1995 touchant l’anesthésie ont été révisées et les articles de langue anglaise publiés sur les dispositifs de contrôle des voies aériennes ont été analysés. Les sources secondaires de renseignements se rapportaient à l’obstruction respiratoire. Le tout a été complété en référant aléatoirement aux manuels en usage.

Résultats

Les nombreux objectifs du ML n’étaient pas, du moins en partie, en règle générale décrits au moment de l’introduction de la canule oropharyngée par Hewitt en 1908 et ont été négligés jusqu’à maintenant.

Conclusion

La conception des canules reposait sur un contexte clinique et des besoins perçus à l’époque. Aujourd’hui, des situations cliniques distinctes surviennent encore et il existe un rôle distinct pour les différents dispositifs. Présentement, pour la gestion sus-glottique des voies aériennes pendant l’anesthésie générale, quatre types de dispositifs devraient être disponibles: la canule Guedel, la canule nasopharyngée, le masque laryngé et un dispositif conçu spécialement pour faciliter l’intubation trachéale à l’aveugle.

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Correspondence to John W. R. McIntyre.

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McIntyre, J.W.R. Oropharyngeal and nasopharyngeal airways: I (1880–1995). Can J Anaesth 43, 629 (1996). https://doi.org/10.1007/BF03011778

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Keywords

  • Airway Management
  • Laryngeal Mask Airway
  • Cricoid Pressure
  • Respiratory Obstruction
  • Masque Laryng