CME Module 10: Recent Developments in Supraglottic Airway Devices Next >

 

Introduction

 

Abbreviations used in this Module

BMI Body Mass Index
COPA Cuffed Oropharyngeal Airway
ETT Endotracheal Tube
ILA Intubating Laryngeal Airway
LMA Laryngeal Mask Airway
LT Laryngeal Tube

 

For years the endotracheal tube (ETT) has played a preeminent role in clinical airway management. Now, however, a number of supraglottic airway devices such as the laryngeal mask airway (LMA) and its many variants are adding to the armamentarium available to clinicians. Less invasive than endotracheal intubation, supraglottic airway devices are now especially popular in outpatient surgery as well as as rescue devices in the management of some clinical airway crises. This presentation deals with the clinical use of various forms of supraglottic airway devices, focusing on some recent developments expected to be of interest to the clinical practitioner.

This revolution in clinical airway management began with the introduction of the LMA. First made available to clinicians in 1988, this device was invented by Dr. Archie Brain in a development effort that spanned 7 years. Much of this early work was based on the study of laryngeal anatomy using cast models, while more recent studies sometimes make use of MRI and CT imaging modalities. In recent years, as the LMA and its numerous variants have been in large volume use, considerable clinical experience in supraglottic airway techniques has been accumulated - as evidenced by the many thousands of published articles dealing with supraglottic airway techniques, as well as by their worldwide adoption and their proven safety record.

Because the conventional LMA is now well-known to almost all anesthesiologists, the focus of this article will be on supraglottic airway devices and techniques that have evolved since the earlier years of LMA use. For those interested in a history of the development of the LMA, a paper by Dr. Brain [1] will be of interest. For those interested in a comprehensive textbook concerning the LMA, the definitive volume by Brimacombe et al., now in its second edition, is heartily recommended [2].

 

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