Laryngeal mask

Laryngeal Mask

A laryngeal mask is a medical device that is used to keep a patient's airway open during anesthesia or unconsciousness. It is a type of supraglottic airway device that is designed to sit over the laryngeal inlet (the entrance to the trachea and lungs) without entering the trachea itself. This distinguishes it from other airway devices such as endotracheal tubes, which are inserted into the trachea.

History

The laryngeal mask was invented by Dr. Archie Brain in the early 1980s and has since become a commonly used device in anesthesia. Its development was a significant advancement in airway management, providing an alternative to traditional methods like face masks and endotracheal intubation.

Design

The device consists of an airway tube that connects to an elliptical mask with a cuff. When the device is inserted into the patient's mouth, the mask aligns with the laryngeal inlet. The cuff can then be inflated to create a seal around the laryngeal inlet, allowing for effective ventilation of the lungs.

Types

There are several types of laryngeal masks, including:

• Standard laryngeal mask airway (LMA): The original design, suitable for most anesthesia applications.
• Reinforced LMA: Features a reinforced airway tube to prevent kinking, useful in surgeries where the patient's head and neck are positioned in a way that might compress a standard LMA.
• Disposable LMA: Designed for single use to reduce the risk of cross-infection.
• Intubating LMA (ILMA): Allows for endotracheal intubation through the laryngeal mask, providing a pathway for more secure airway control if needed.

Indications

Laryngeal masks are indicated for use in various surgical procedures where general anesthesia is administered, and the patient's spontaneous breathing may be inadequate. They are particularly useful in cases where endotracheal intubation is difficult or not necessary. However, they are not suitable for all patients, especially those at risk of aspiration due to a full stomach, obesity, or pregnancy.

Contraindications

Contraindications for the use of a laryngeal mask include:

• Risk of aspiration
• Lack of access to the mouth
• Severe reflux or gastrointestinal obstruction
• Need for high airway pressures

Complications

While generally safe, the use of laryngeal masks can be associated with certain complications, such as:

• Displacement or dislodgement
• Aspiration of stomach contents
• Airway trauma
• Nerve damage
• Sore throat

Insertion Technique

The insertion of a laryngeal mask involves several steps to ensure proper placement and sealing. It typically requires less force and is less invasive than endotracheal intubation, making it a less stressful alternative for both the patient and the healthcare provider.

Conclusion

The laryngeal mask is a valuable tool in airway management, offering an effective alternative to both face masks and endotracheal tubes in many surgical settings. Its design and variety of types make it adaptable to a wide range of patients and procedures, contributing to its widespread use in modern anesthesia practice.