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.

[1]  F. W. Wittmann,et al.  Laryngeal mask and gastric dilatation , 1991, Anaesthesia.

[2]  J. Nolan,et al.  Aspects of resuscitation in trauma. , 1997, British journal of anaesthesia.

[3]  A. Cros,et al.  Severe dysphonia after use of a laryngeal mask airway. , 1997, Anesthesiology.

[4]  F. Goto,et al.  Unilateral hypoglossal nerve paralysis following the use of the laryngeal mask airway , 1994, Anaesthesia.

[5]  R. Wenstone,et al.  The Laryngeal Mask Airway and Positive‐pressure Ventilation , 1994, Anesthesiology.

[6]  S. M. Edwards,et al.  Retrograde intubation through a laryngeal mask airway. , 1996, Anesthesiology.

[7]  R Roden,et al.  The laryngeal mask airway , 1992, Anaesthesia.

[8]  W. Young,et al.  A Prospective Evaluation of Clinical Tests for Placement of Laryngeal Mask Airways , 1998, Anesthesiology.

[9]  N. Hwang,et al.  The intubating laryngeal mask airway (ILMA): initial experience in Singapore. , 1998, British journal of anaesthesia.

[10]  W. A. Hunter,et al.  Training nursing staff in airway management for resuscitation , 1993, Anaesthesia.

[11]  J. Bahk,et al.  A method for removing the laryngeal mask airway after using it as an intubation guide. , 1997, Anesthesiology.

[12]  T. Ebert,et al.  Neurocirculatory responses to intubation with either an endotracheal tube or laryngeal mask airway in humans. , 1996, Journal of clinical anesthesia.

[13]  G. Greenslade,et al.  Laryngeal mask airway and tracheal tube insertion by unskilled personnel , 1990, The Lancet.

[14]  A. Kapila,et al.  The intubating laryngeal mask. I: Development of a new device for intubation of the trachea. , 1997, British journal of anaesthesia.

[15]  E. Forrest,et al.  Haemodynamic response to insertion of laryngeal mask , 1989 .

[16]  C. King,et al.  Twelfth cranial nerve paralysis following use of a laryngeal mask airway , 1994, Anaesthesia.

[17]  K. Wareham,et al.  A comparative study of the incidence of sore throat with the laryngeal mask airway , 1994, Anaesthesia.

[18]  A. Brain,et al.  Lingual nerve injury associated with laryngeal mask use , 1998, Anaesthesia.

[19]  R. Marjot.  Trauma to the posterior pharyngeal wall caused by a laryngeal mask airway , 1991, Anaesthesia.

[20]  F. Agrò,et al.  The intubating laryngeal maskClinical appraisal of ventilation and blind tracheal intubation in 110 patients , 1998, Anaesthesia.

[21]  E. Crosby,et al.  The unanticipated difficult airway with recommendations for management , 1998, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[22]  M. Heath,et al.  Intubation through the laryngeal mask , 1991, Anaesthesia.

[23]  J. Brimacombe,et al.  An algorithm for use of the laryngeal mask airway during failed intubation in the patient with a full stomach. , 1993, Anesthesia and analgesia.

[24]  J. Brimacombe,et al.  The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature. , 1995, Journal of clinical anesthesia.

[25]  A. Pearce,et al.  Aspiration pneumonia and the laryngeal mask airway , 1991, Anaesthesia.

[26]  A. Kapila,et al.  The intubating laryngeal mask airway: an initial assessment of performance. , 1997, British journal of anaesthesia.

[27]  K. Kokkinis.  The use of the laryngeal mask airway in CPR. , 1994, Resuscitation.

[28]  K. Shingu,et al.  Use of a lighted stylet for tracheal intubation through the intubating laryngeal mask. , 1998, Anesthesia and analgesia.

[29]  R. Howard-Griffin,et al.  Midazolam co‐induction and laryngeal mask insertion , 1996, Anaesthesia.

[30]  N. Denny,et al.  Laryngeal mask airway for emergency tracheostomy in a neonate , 1990, Anaesthesia.

[31]  J. Brimacombe,et al.  Difficult airway management with the intubating laryngeal mask. , 1997, Anesthesia and analgesia.

[32]  B Stone,et al.  The laryngeal mask in cardiopulmonary resuscitation in a district general hospital: a preliminary communication. , 1993, Resuscitation.

[33]  G. Smith,et al.  The laryngeal mask airway and the tracheal route for drug administration. , 1997, British journal of anaesthesia.

[34]  J. Brimacombe,et al.  Effect of cricoid pressure on ease of insertion of the laryngeal mask airway. , 1993, British journal of anaesthesia.

[35]  D. Tay,et al.  A comparison of three types of tracheal tube for use in laryngeal mask assisted blind orotracheal intubation , 1994, Anaesthesia.

[36]  N Yardy,et al.  A comparison of two airway aids for emergency use by unskilled personnelThe Combitube and laryngeal mask , 1999, Anaesthesia.

[37]  S. Morris,et al.  The laryngeal mask airway: its features, effects and role , 1994, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[38]  J. J. Lee.  Laryngeal mask and trauma to uvula , 1989, Anaesthesia.

[39]  J. Brimacombe,et al.  The Laryngeal Mask Airway in Emergency Medicine, Neonatal Resuscitation, and Intensive Care Medicine , 1998, International anesthesiology clinics.

[40]  J. J. Lee,et al.  LMA and respiratory arrest after anterior cervical fusion , 1993, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[41]  D. Hett,et al.  The laryngeal mask airway in resuscitation. , 1994, Resuscitation.

[42]  J. Maltby,et al.  Laryngeal mask airway with mouth opening less than 20 mm , 1995, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[43]  T. Cook.  Bronchospasm and the laryngeal mask airway , 1994, Anaesthesia.

[44]  J. Brimacombe,et al.  The laryngeal mask airway. , 1996, Journal of post anesthesia nursing.

[45]  D J Reinhart,et al.  Comparison of placement of the laryngeal mask airway with endotracheal tube by paramedics and respiratory therapists. , 1994, Annals of emergency medicine.

[46]  A. Brain.  Bronchospasm and the laryngeal mask airway , 1994, Anaesthesia.

[47]  J. Brimacombe,et al.  Laryngeal mask airway in pediatric practice: a prospective study of skill acquisition by anesthesia residents. , 1996 .

[48]  G. Smith,et al.  Cardiovascular responses to insertion of the laryngeal mask , 1992 .

[49]  A. Mccrirrick,et al.  Awake intubation: a new technique , 1991, Anaesthesia.

[50]  H. Toyooka,et al.  RETRACTED ARTICLE: Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients , 1995, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[51]  J. Brimacombe,et al.  Survey of Laryngeal Mask Airway Usage in 11,910 Patients: Safety and Efficacy for Conventional and Nonconventional Usage , 1996, Anesthesia and analgesia.

[52]  M. Stacey,et al.  Ease of placement of the laryngeal mask during manual in-line neck stabilization. , 1998, British journal of anaesthesia.

[53]  P. Baskett,et al.  The incidence of regurgitation during cardiopulmonary resuscitation: a comparison between the bag valve mask and laryngeal mask airway. , 1998, Resuscitation.

[54]  L. Mcnicol.  Insertion of laryngeal mask airway in children , 1991, Anaesthesia.

[55]  H. Crockard,et al.  The Brain laryngeal mask airway An alternative to emergency tracheal intubation , 1990, Anaesthesia.

[56]  A. Brain.  The laryngeal mask--a new concept in airway management. , 1983, British journal of anaesthesia.

[57]  P. Hopkins,et al.  Bilateral lingual nerve injury following the use of the laryngeal mask airway , 1998, Anaesthesia.

[58]  P. Suratt,et al.  Resistance to Breathing in Healthy Subjects following Endotracheal Intubation under Topical Anesthesia , 1980, Anesthesia and analgesia.

[59]  Bell Mh.  Midazolam co-induction and laryngeal mask insertion. , 1997 .

[60]  A. Brain.  Historical Aspects and Future Directions , 1998, International anesthesiology clinics.

[61]  H. Joo,et al.  Fastrach — a new intubating laryngeal mask airway: successful use in patients with difficult airways , 1998, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[62]  J. Brimacombe,et al.  The Intubating Laryngeal Mask Airway , 1998, International anesthesiology clinics.

[63]  C. Rumball,et al.  The PTL, Combitube, laryngeal mask, and oral airway: a randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. , 1997, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[64]  H. Goto,et al.  The Effectiveness of the Fukuhara Laryngeal Mask Airway Holding Forceps (F Forceps) , 1997, Anesthesia and analgesia.

[65]  J. Brimacombe.  Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia , 1996, Anaesthesia.

[66]  J. Dingley,et al.  Insertion methods of the laryngeal mask airway , 1996, Anaesthesia.

[67]  A. Allison,et al.  Tracheal placement of a gum elastic bougie using the laryngeal mask airway , 1990, Anaesthesia.

[68]  C. Verghese,et al.  Prospective survey of the use of the laryngeal mask airway in 2359 patients , 1993, Anaesthesia.

[69]  C. Heard,et al.  Fiberoptic-guided endotracheal intubation via the laryngeal mask airway in pediatric patients: a report of a series of cases. , 1996, Anesthesia and analgesia.

[70]  J. Staples,et al.  Comparison of the Anesthetic Requirement for Tolerance of Laryngeal Mask Airway and Endotracheal Tube , 1992, Anesthesia and analgesia.

[71]  A. Davey,et al.  Emergency use of the laryngeal mask airway in severe upper airway obstruction caused by supraglottic oedema. , 1995, British journal of anaesthesia.

[72]  G. Leader.  Facilitation of the insertion of the laryngeal mask , 1991, Anaesthesia.

[73]  J. Nolan,et al.  Guidelines for the basic management of the airway and ventilation during resuscitation. A statement by the Airway and Ventilation Management Working Group of the European Resuscitation Council. , 1996, Resuscitation.

[74]  T. Asai.  Fiberoptic tracheal intubation through the laryngeal mask in an awake patient with cervical spine injury. , 1993, Anesthesia and analgesia.

[75]  T. Oh,et al.  Resistance and additional inspiratory work imposed by the laryngeal mask airway , 1992, Anaesthesia.

[76]  J. Brimacombe.  Problems with the Laryngeal Mask Airway: Prevention and Management , 1998, International anesthesiology clinics.

[77]  N. Braude,et al.  The pressor response and laryngeal mask insertion , 1989, Anaesthesia.

[78]  M. Sasada,et al.  Tracheal intubation through the laryngeal mask using a gum elastic bougie in the presence of cricoid pressure and manual in line stabilisation of the neck , 1996, Anaesthesia.

[79]  A. Asbury,et al.  Cardiovascular response to insertion of Brain's laryngeal mask , 1990, Anaesthesia.

[80]  N. Gajraj,et al.  Role of the laryngeal mask airway in the immobile cervical spine. , 1993, Journal of clinical anesthesia.

[81]  B. Milne,et al.  Use of the laryngeal mask prior to definitive intubation in a difficult airway: a case report. , 1995, The Journal of emergency medicine.

[82]  D. Smith,et al.  A review of etomidate for rapid sequence intubation in the emergency department. , 1997, The Journal of emergency medicine.

[83]  F. R. Ellis,et al.  Comparison of propofol and thiopentone for laryngeal mask insertion , 1991, Anaesthesia.

[84]  A. Steel,et al.  The intubating laryngeal mask airway , 2004, Emergency Medicine Journal.

[85]  J. Brimacombe,et al.  The intubating laryngeal mask. II: A preliminary clinical report of a new means of intubating the trachea. , 1997, British journal of anaesthesia.

[86]  J. Nolan,et al.  The intubating laryngeal maskResults of a multicentre trial with experience of 500 cases , 1998, Anaesthesia.

[87]  C. Keller,et al.  Pharyngeal mucosal pressures, airway sealing pressures, and fiberoptic position with the intubating versus the standard laryngeal mask airway. , 1999, Anesthesiology.

[88]  F R Lloyd Jones,et al.  Recurrent laryngeal nerve palsy after laryngeal mask airway insertion , 1996, Anaesthesia.

[89]  W. Rosenblatt,et al.  The intubating laryngeal mask: use of a new ventilating-intubating device in the emergency department. , 1999, Annals of emergency medicine.

[90]  J. Moore,et al.  Laryngeal mask airway for Caesarean section , 1990, Anaesthesia.

[91]  N. Weir,et al.  Recurrent laryngeal nerve palsy and the laryngeal mask airway , 1996, Anaesthesia.

[92]  J. Brimacombe,et al.  Laryngeal mask airway insertion , 1993, Anaesthesia.

[93]  Webster Nr,et al.  The laryngeal mask airway. A study of 100 patients during spontaneous breathing. , 1989 .

[94]  D. Gabbott,et al.  The role of the laryngeal mask airway in pre-hospital care. , 1994, Resuscitation.

[95]  J. Brimacombe,et al.  Mallampati classification and laryngeal mask airway insertion , 1993, Anaesthesia.

[96]  A. Brain.  Laryngeal mask airway. , 1992, Anesthesiology.

[97]  J. Ansermino,et al.  Cricoid pressure may prevent insertion of the laryngeal mask airway. , 1992, British journal of anaesthesia.

[98]  J. Brimacombe,et al.  Insertion of the Laryngeal Mask Airway—A Prospective Study of Four Techniques , 1993, Anaesthesia and intensive care.

[99]  I. Power,et al.  Cricoid pressure impedes placement of the laryngeal mask airway. , 1995, British journal of anaesthesia.

[100]  Paul F. White,et al.  The Laryngeal Mask Airway Its Uses in Anesthesiology , 1993, Anesthesiology.

[101]  R. Cantor,et al.  Rapid-Sequence Intubation of the Pediatric Patient , 1996 .

[102]  J. Maltby,et al.  The laryngeal mask airway: clinical appraisal in 250 patients , 1990, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[103]  P. Szmuk,et al.  Laryngeal mask and pulmonary edema. , 1993, Anesthesiology.

[104]  J. Benumof,et al.  Laryngeal mask airway. Indications and contraindications. , 1992, Anesthesiology.

[105]  J. Brock‐Utne,et al.  An Airway Management Device: The Laryngeal Mask Airway—A Review , 1998 .

[106]  C. Hagberg,et al.  Blind intubation through the laryngeal mask airway for management of the difficult airway in infants. , 1996, Anesthesiology.

[107]  A. Brain.  Course of the hypoglossal nerve in relation to the position of the laryngeal mask airway , 1995, Anaesthesia.

[108]  Jonathan L. Benumof,et al.  Laryngeal Mask Airway and the ASA Difficult Airway Algorithm , 1996, Anesthesiology.

[109]  M. Swart,et al.  Ease of insertion of the laryngeal mask airway by inexperienced personnel when using an introducer , 1997, Anaesthesia.

[110]  J. Brimacombe.  EMERGENCY AIRWAY MANAGEMENT IN RURAL PRACTICE: USE OF THE LARYNGEAL MASK AIRWAY , 1995 .

[111]  P. Murphy,et al.  Regurgitation of gastric contents during general anaesthesia using the laryngeal mask airway. , 1992, British journal of anaesthesia.

[112]  P. Baskett,et al.  The intubating laryngeal mask , 1998, Anaesthesia.

[113]  J. Tobias.  The laryngeal mask airway: A review for the emergency physician , 1996, Pediatric emergency care.

[114]  S. Yentis,et al.  Laryngeal mask airway and lingual nerve injury , 1996, Anaesthesia.

[115]  C. Laxton.  Lingual nerve paralysis following the use of the laryngeal mask airway , 1996, Anaesthesia.

[116]  J. Brimacombe.  Cricoid pressure and the laryngeal mask airway. , 1991, Anaesthesia.

[117]  P. Narchi,et al.  IS LARYNGEAL MASK EASY TO USE IN CASE OF DIFFICULT INTUBATION , 1992 .

[118]  I. Power,et al.  Cricoid pressure impedes placement of the laryngeal mask airway and subsequent tracheal intubation through the mask. , 1994, British journal of anaesthesia.

[119]  C. Mason,et al.  Spread of intrapulmonary adrenaline administered via the laryngeal mask , 1997 .

[120]  M. Harrison,et al.  Ketamine and propofol for TIVA , 1991, Anaesthesia.

[121]  Y. Kadota,et al.  Application of a laryngeal mask to a fiberoptic bronchoscope-aided tracheal intubation. , 1992, Journal of clinical anesthesia.

[122]  P. White,et al.  Use of the laryngeal mask airway as an alternative to a face mask during outpatient arthroscopy. , 1992, Anesthesiology.

[123]  M. Parry,et al.  The laryngeal mask airway as an adjunct to extubation on the intensive care unit , 1996, Anaesthesia.

[124]  R. Loken,et al.  The laryngeal mask airway as an aid to blind orotracheal intubation , 1992, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[125]  J. Storey.  The laryngeal mask for failed intubation at caesarean section. , 1992, Anaesthesia and intensive care.

[126]  T. Ammar,et al.  The laryngeal mask airway , 1990 .

[127]  J. Brimacombe,et al.  The laryngeal mask airway. , 1993, Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS.

[128]  G. Joshi,et al.  Intubation through the laryngeal mask airway. , 1995, Anesthesiology.

[129]  P Martens,et al.  The use of the laryngeal mask airway by nurses during cardiopulmonary resuscitation , 1994, Anaesthesia.

[130]  W. Mccaughey,et al.  Laryngeal mask placement in the prone position , 1993, Anaesthesia.

[131]  R. Marjot.  Pressure exerted by the laryngeal mask airway cuff upon the pharyngeal mucosa. , 1993, British journal of anaesthesia.

[132]  Brain Ai.  An evaluation of the laryngeal mask airway during routine paediatric anaesthesia. , 1995 .

[133]  Jones Kl,et al.  Tongue cyanosis after laryngeal mask airway insertion. , 1994 .

[134]  A. E. el Dawlatly,et al.  The role of laryngeal mask airway in cardiopulmonary resuscitation. , 1994, Resuscitation.

[135]  H. Wakeling,et al.  The Laryngeal Mask Airway: A Comparison Between Two Insertion Techniques , 1997, Anesthesia and analgesia.

[136]  M. Schreiner,et al.  Insertion of the laryngeal mask airway in awake infants with the Robin sequence. , 1992, Anesthesia and analgesia.

[137]  M. Bishop,et al.  Endotracheal intubation, but not laryngeal mask airway insertion, produces reversible bronchoconstriction. , 1998, Anesthesiology.

[138]  J. Maltby,et al.  Acute transient unilateral macroglossia following use of a LMA , 1996, Canadian journal of anaesthesia = Journal canadien d'anesthesie.