The Significance of the Laryngeal Airway Mask in Airway Management

mask in airway mgmt

The Significance of the Laryngeal Airway Mask in Airway Management

Since the introduction of the laryngeal airway mask (LAM) by Dr. Archie Brain in the 1980’s, it has continually changed airway management globally. Initially, having difficulty in convincing many that this is the future of airway management and finding a company interested enough, Dr. Brain persisted. Many anesthetists initially thought it had little to no significance in airway management. Many were quoted with saying things such as, “I like to mask ventilate my own patient”. The average practicing anesthesiologist in that day could never have imagined the significance that the laryngeal airway mask would eventually have in airway management.

Now let’s fast forward some thirty years. Dr. Brain’s invention has been used hundreds of millions of times throughout the globe. In fact, the laryngeal airway mask is not only used for convenience, but also typically provides a superior seal for supraglottic ventilation. It has evolved to become the rescue airway device of the world for CICO (Cannot Intubate, Cannot Oxygenate) situations. These devices are incorporated in essentially all airway management rescue scenarios. In some studies, the laryngeal airway mask has shown its competence to be placed and ventilate in some 95% of patients. It has also been shown to be less stimulating and less traumatic than standard intubation. Years ago, anesthetists would have never thought that supraglottic ventilation would merge into the pathways of intubation. Methods of utilizing the laryngeal airway mask as a conduit for intubation have been devised. Many techniques and LAM devices have been developed to provide blind or visualized intubation. The flexible fiber optic scope/bronchoscope have been used in providing visualization and a guided pathway to the vocal cords. Typically, a LAM combined with a fiber optic scope is simpler to teach then standard fiber optic intubation alone. The ability to ventilate and intubate at the same time has been demonstrated. This obviously has tremendous benefits in rescuing an airway.

medical deviceIn comparison, the standard laryngoscope was invented some 100 years ago. It provided the ability for physicians to visualize and start the process of diagnosing airway diseases. Over time, intubation has developed the ability to secure the airway and ventilate patients. This allowed for not only a safer environment for surgery, but also a greater innovation in the surgical theater. It revolutionized both anesthesia and surgery, creating a rapid evolution in both specialties. Surgeons could now operate on patients in multiple positions with greater ease in surgical technique. Anesthesiologists were able to safely ventilate patients hand free and from greater distances. Capnography provided an additional way to verify ventilation throughout surgery and pulse oximetry brought greater safety, verifying oxygenation in patients. Advancement in camera technology provided greater innovations in surgery as well as anesthesia. The video laryngoscope invented in the 1980’s helped advance airway management and created an easier learning curve for routine intubation.

The laryngoscope has been synonymous with intubation for nearly 100 years. Its place in history has been well documented but it clearly has its own limitations. A laryngoscope/video laryngoscope are very stimulating and uncomfortable to place. Because of its rigid nature, they can be traumatic to tissues, teeth and gums. The forces utilized with intubation are lessened with the video laryngoscope but are still substantial. Most times, a standard laryngoscopy is conducted in paralyzed patients removing their ability to spontaneously breathe leading to obvious potential disasters in airway management. There is no ability to ventilate a patient while conducting laryngoscopy and no continued visualization for any extended period of time after placement of an endotracheal tube.

People could argue that a laryngeal airway mask is more of an inclusive airway management device. It is easy to place, less stimulating and less traumatic than standard intubation. However, intubation is still the gold standard for securing an airway. Maybe we should be looking at ALL the possibilities within the continuum of airway management: ventilation, visualization, intubation, verification, extubation and reestablishing ventilation again if need be.

The new paradigm shift should be moving toward devices that simplify ALL the ideal qualities within this continuum.

Up Next

article

It All Adds Up: The New Face of Supraglottic Superiority

article

Ideal Qualities of Airway Management Devices & Systems

article

The Inventor’s Point of View