An asthmatic weaned from a ventilator using a laryngeal mask

An Airway Management Device: The Laryngeal Mask Airway—A Review

The laryngeal mask airway (LMA) is an airway management device that has become an accepted part of anesthetic practice in both pediatric and adults surgical patients. It is inserted without the use of a laryngoscope or muscle relaxants into the hypopharynx forming a low pressure seal around the glottis. The LMA provides a better airway than a face mask with or without an oral airway. Insertion techniques are quickly learned and are described in this review. Since the LMA forms a less secure seal than an endotracheal tube (ETT), several important limitations and contraindications exist. This includes patients at high risk for regurgitation of gastric contents into the lungs causing pulmonary aspiration and patients requiring high ventilatory pressures or prolonged ventilation. These contraindications have limited its introduction and utilization in the intensive care unit (ICU). The LMA is a helpful tool in the management of both the expected and unexpected difficult airway, where it may serve both as an emergency airway and as a conduit to intubation of the trachea with an ETT over a fiberoptic bronchoscope (FOB) or gum elastic bougie. A lifesaving airway has been provided by the LMA where no other means of achieving ventilation were possible in patients, including neonates, trauma victims, woman undergoing cesarean section, and in the setting of cardiac arrest. There are very few reported uses of the LMA in the ICU. We believe that familiarity with the LMA's design, use, and limitations by critical care practitioners will increase its use in emergency airway management and in the ICU. The LMA may prove to be the first of a new generation of airway devices placed into the hypopharynx to provide an alternative to the endotracheal tube and mask airway.

Successful pharyngeal pulse oximetry in low perfusion states

PURPOSE

We describe pharyngeal oximetry with the laryngeal mask airway in two patients with low perfusion states where finger oximetry failed.

CLINICAL FEATURES

One patient was a 47-yr-old man with septic shock and the other a 64-yr-old man with multiorgan failure. In both patients, a # 4 laryngeal mask airway with a pediatric pulse oximeter probe was inserted behind the tracheal tube. A good waveform was obtained and oxygen saturation was 0-2% lower than arterial samples.

CONCLUSION

Pharyngeal oximetry with the laryngeal mask airway is feasible in low perfusion states when finger oximetry fails.

The laryngeal mask airway: potential applications in neonatal health care

The laryngeal mask airway is a completely new concept in airway management and has the potential to provide a third airway option for the neonate. The device sits in the hypopharynx at the interface between the gastrointestinal and respiratory tracts, where it forms a circumferential low-pressure seal around the glottis. This article provides an overview of the laryngeal mask airway and focuses on its potential as a neonatal airway outside the operating room.