The Effectiveness of the Fukuhara Laryngeal Mask Airway Holding Forceps (F Forceps)

Insertion of the LMA-Unique™ with and without digital intraoral manipulation by inexperienced personnel after manikin-only training

In a randomized, crossover study, we compared insertion of the LMA-Unique with and without digital intraoral manipulation by inexperienced personnel after manikin-only training. Ten registered nurses with no hands-on clinical experience of airway management and 100 anesthetized, paralyzed adults (ASA Status 1-2, aged 18-80 years) participated in the trial. Training comprised: 1) a 30-min didactic lecture; 2) a 3-min description of each of the insertion techniques; 3) a 3-min demonstration of each technique using a manikin; 4) 10 min of supervised training on the manikin with each technique. The time to achieve an effective airway (2 consecutive expired tidal volumes >/= 8 ml/kg; maximum 90 s or 3 attempts allowed) and the number of insertion attempts were determined by analysis of digital video recordings. Any blood staining on the first randomized device was noted at removal. The first attempt success rate (with digital intraoral manipulation, 84%; without digital intraoral manipulation, 87%) and overall success rate (with digital intraoral manipulation, 94%; without digital intraoral manipulation, 93%) were similar. Effective airway time was shorter without digital intraoral manipulation (43 +/- 17 vs. 33 +/- 15 s). Blood staining was detected in 12% (6/50) with and 16% (8/50) without digital intraoral manipulation (not significant). There were no differences in performance among nurses. We conclude that insertion of the LMA-Unique is equally successful with or without digital intraoral manipulation by inexperienced personnel in paralyzed adults after manikin-only training. Successful insertion of the LMA-Unique does not require insertion of the finger into the patient's mouth.

The laryngeal mask airway: a comprehensive review for the Emergency Physician

The Laryngeal Mask Airway (LMA) was developed in the 1980s, but has only recently begun to be used in Emergency Medicine. The LMA affords effective assisted ventilation without requiring endotracheal intubation or visualization of the glottis. In doing so, it is more efficacious than a bag-valve-mask apparatus, although the risk of aspiration of gastric contents persists, particularly if the device is not properly placed. The LMA also has significant potential utility in management of the difficult airway. Most reported clinical experience with the LMA has come from the operating room. This article provides an overview of the extensive potential utility of the LMA in the Emergency Department and prehospital settings as well as a comprehensive review of the pertinent advantages, disadvantages, and complications associated with its use.

Bridges to establish an emergency airway and alternate intubating techniques

In this article, a number of alternatives to direct laryngoscopy are examined. These alternatives include the laryngeal mask airway (LMA; LMA North America, San Diego, CA), cuffed oropharyngeal airway (COPA; Mallinckrodt, St. Louis, MO), and Combitube (Kendall-Sheridan, Mansfield, MA), that have been designed to act as bridges to establish an airway. Other devices, such as rigid stylets, the lightwand (a blind technique) and indirect fiberoptic rigid stylets, such as the Bullard scope, Upsher scope, and Wu scope are also briefly discussed.