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The laryngeal mask airway (LMA) is a novel device that fills the gap in airway management between that of endotracheal intubation and the use of a face mask. It was introduced in the United Kingdom in 1983 by British anesthesiologist A. I. J. Brain. His goal was to develop an airway apparatus that could rapidly overcome an obstructed airway, is simple to use, and is atraumatic to insert. In 1991, the LMA was approved for use in the United States by the U.S. Food and Drug Administration.


The LMA was designed primarily as a means of providing ventilatory support while avoiding the fundamental disadvantage of the need to visualize and penetrate the vocal cords with an endotracheal tube.1 The LMA is introduced into the hypopharynx without visual control. It forms a low-pressure seal around the laryngeal inlet and permits positive-pressure ventilation. In fact, with the introduction of the new LMA Proseal, pressures of up to 30 cmH2O may be administered safely (A. I. Brain, M.D., personal communication). Once inserted, the LMA may be used as a conduit for fiberoptically guided endotracheal intubation or to place an endotracheal tube blindly.2 Since it was initially described, the LMA has come to be viewed as a viable method of airway management, with over 800 articles and case reports describing the advantages and disadvantages of the device.3


Many disadvantages of the standard LMA became apparent with widespread use of the device. More than 10 years after its introduction, Brain et al began to work on a new airway system with better intubation characteristics than the standard LMA. The intubating laryngeal mask airway (ILMA) was developed through the aid of analysis of magnetic resonance images of the human pharynx and laboratory testing of endotracheal tubes.4 The new and more “anatomically correct” ILMA effects more precise placement. The design of the ILMA also avoids head and neck manipulation and insertion of the intubator’s fingers in the patient’s mouth, both of which occur during the placement of the standard LMA.4,5


There are currently five models of the LMA. The LMA-Classic is the original and most commonly used version. It is the model referred to in this chapter as the LMA. The LMA-Flexible is a wire-reinforced version of the LMA that is more flexible than the original version and resists kinking. It is used by Anesthesiologists for patients undergoing head and neck procedures. It is not used in the Emergency Department. The LMA-Fastrach is a modified version of the LMA that allows endotracheal intubation through the unit. It is also referred to as the intubating laryngeal mask airway (ILMA). It allows ventilation during intubation attempts. Its advantages include the following: no manipulation of the head and neck is required, it can accommodate up to a size 8 endotracheal tube, it facilitates one-handed insertion, it can be inserted from the patient’s side or from above the head, and ...

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