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Introduction to the Laryngeal Mask Airway

 

For years, (and even now) the endotracheal tube (ETT) has served a pre-eminent role in airway management. Now a new approach, use of the laryngeal mask airway (LMA), is taking its place across the world in the repertoire of techniques available to the anaesthetist. The technique is especially popular in outpatient surgery, but has also proven to be life-saving in the management of airway crises. This presentation deals with the history, technology and clinical use of the LMA. The focus of this presentation concerns the LMA-Classic and the LMA-Flexible. Dr. Archie I. J. Brain, inventor of the LMA, continues to create additions to and variations of the original LMA.

At present, these include seven sizes of the original (LMA-Classic), a single-use LMA (LMA-Unique), a reinforced/flexible LMA (LMA-Flexible), an LMA specifically designed for tracheal intubation (LMA-Fastrach) and the LMA-ProSeal / LMA Supreme, designed for applications where the patient is at increased risk of aspiration. The latter three products are not discussed in this introductory presentation.

The original LMA was invented in a development effort by Dr. Archie Brain (Figure 1) spanning the years from 1981 to 1988. When inserted, the LMA lies "at the crossroads of the digestive and respiratory tracts" (Figure 2). Much of the development was based on the study of laryngeal anatomy using cast models (Figure 3). Dr. Brain has published a history of the development of the LMA (Brain 1991) which will be of interest to many readers.

Archie Brain
Figure 1. (Unflattering) photograph of Dr. Archie Brain (still from the LMA video)
Diagram of LMA positioning
Figure 2. Position of the LMA "seated at the crossroads of the respiratory and digestive tracts" after insertion.
Laryngeal cast used by Dr. Brain
Figure 3. Sample of a laryngeal cast used by Dr. Brain in the development of the LMA

Considerable clinical experience in the LMA has now been accumulated since the first production model in 1988, as evidenced by the many thousands of  publications concerning its use, as well as by its world-wide adoption.

 


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