Subject(s)
Laryngeal Masks , Manometry , Pharyngitis/prevention & control , Standard of Care , Humans , PressureSubject(s)
Cervical Vertebrae , Intubation, Intratracheal/methods , Laryngeal Masks , Adult , Cadaver , Child , Clinical Trials as Topic , Emergencies , Fiber Optic Technology , Humans , Intubation, Intratracheal/instrumentation , Laryngoscopy , Multicenter Studies as Topic , Risk Factors , Spinal Fractures/complicationsSubject(s)
Laryngeal Masks , Equipment Design , Fiber Optic Technology , Humans , Intubation, Intratracheal/methodsABSTRACT
We describe a new laryngeal mask airway (LMA) that incorporates a second tube placed lateral to the airway tube and ending at the tip of the mask. The second tube is intended to separate the alimentary and respiratory tracts. It should permit access to or escape of fluids from the stomach and reduce the risks of gastric insufflation and pulmonary aspiration. It can also determine the correct positioning of the mask. A second posterior cuff is fitted to improve the seal. A preliminary crossover comparison with the standard mask in 30 adult female patients showed no differences in insertion, trauma or quality of airway. At 60 cm H2O intracuff pressure, the new LMA gave twice the seal pressure of the standard device (P < 0.0001) and permitted blind insertion of a gastric tube in all cases. It is concluded that the new device merits further study.
Subject(s)
Drainage/instrumentation , Laryngeal Masks , Adult , Aged , Cross-Over Studies , Equipment Design , Feasibility Studies , Female , Humans , Insufflation , Middle Aged , Pneumonia, Aspiration/prevention & control , Stomach Diseases/prevention & controlABSTRACT
This case illustrates that a new prototype laryngeal mask with high seal pressures can be placed in the awake patient with minimal cardiorespiratory changes and that it facilitates passage of a nasogastric tube.
Subject(s)
Anesthesiology/instrumentation , Aneurysm, False/surgery , Femoral Artery/surgery , Laryngeal Masks , Peripheral Vascular Diseases/surgery , Aged , Emergency Treatment , Equipment Design , Humans , Male , Treatment OutcomeABSTRACT
We have assessed a prototype laryngeal mask airway (pLMA) in 50 anaesthetized children for ease of insertion, oropharyngeal leak pressures, gastric insufflation and fibreoptic position. The pLMA has a second smaller mask, which rests against the upper oesophageal sphincter, and a second cuff to increase the seal pressure of the glottic mask. All insertions were graded as easy and an effective airway was achieved in all patients. Oropharyngeal leak pressure was > 40 cm H2O in 49 of 50 patients. Gastric insufflation was not detected by epigastric auscultation. In 46 of 50 patients, the vocal cords were seen via a fibreoptic laryngoscope. One patient regurgitated clear fluid, but aspiration did not occur. On removal, blood staining was detected in three of 50 children. We conclude that the pLMA was easy to insert, facilitated high airway pressure ventilation and may provide some protection against gastric insufflation.
Subject(s)
Laryngeal Masks , Air Pressure , Child , Child, Preschool , Equipment Design , Evaluation Studies as Topic , Female , Gastroesophageal Reflux/etiology , Humans , Infant , Laryngeal Masks/adverse effects , Male , Oropharynx/physiology , Positive-Pressure RespirationABSTRACT
We report the successful use of the intubating laryngeal mask airway in a patient with maxillo-facial trauma for whom the facemask and laryngoscope were relatively contraindicated and the fibreoptic scope potentially difficult to use.
Subject(s)
Facial Bones/injuries , Facial Injuries/surgery , Laryngeal Masks , Skull Fractures/surgery , Adolescent , Contraindications , Female , Fiber Optic Technology , Humans , Laryngoscopy , Masks , Mouth/injuries , Nose/injuries , Tooth Injuries/complicationsSubject(s)
Air , Laryngeal Masks/adverse effects , Stomach , Equipment Design , Equipment Failure , Humans , Pressure , Pulmonary Ventilation/physiology , Tidal VolumeABSTRACT
The standard laryngeal mask airway (LMA) functions both as a ventilatory device and as an aid to blind/fibrescopic-guided tracheal intubation. We describe the radiological and laboratory work used to bioengineer a new laryngeal mask prototype, the intubating laryngeal mask airway (ILMA). The aim was to create a new airway system with better intubation characteristics than the LMA. Other design goals were to eliminate the need for head-neck manipulation and insertion of fingers in the mouth during placement. Development was aided by analysis of magnetic resonance images of the human pharynx and laboratory testing with a variety of tracheal tubes. The principal features of this new system are an anatomically curved, rigid airway tube with an integral guiding handle, an epiglottic elevating bar replacing the mask bars, a guiding ramp built into the floor of the mask aperture and a modified silicone tracheal tube developed for use with the device.
Subject(s)
Laryngeal Masks , Biomedical Engineering , Epiglottis , Equipment Design , Humans , Magnetic Resonance Imaging , Pharynx/anatomy & histology , Radiography , Trachea/diagnostic imagingABSTRACT
We have assessed the efficacy of a new laryngeal mask prototype, the intubating laryngeal mask airway (ILMA), as a ventilatory device and blind intubation guide. The ILMA consists of an anatomically curved, short, wide bore, stainless steel tube sheathed in silicone which is bonded to a laryngeal mask and a guiding handle. It has a single moveable aperture bar, a guiding ramp and can accommodate an 8 mm tracheal tube (TT). After induction of anaesthesia with propofol 2.5 mg kg-1 and fentanyl 2.5 micrograms kg-1, the device was inserted successfully at the first attempt in all 150 (100%) patients and adequate ventilation achieved in all, with minor adjustments required in four patients. Placement did not require movement of the head and neck or insertion of the fingers in the patient's mouth. Blind tracheal intubation using a straight silicone cuffed TT was attempted after administration of atracurium 0.5 mg kg-1. If resistance was felt during intubation, a sequence of adjusting manoeuvres was used based on the depth at which resistance occurred. Tracheal intubation was possible in 149 of 150 (99.3%) patients. In 75 (50%) patients no resistance was encountered and the trachea was intubated at the first attempt, 28 (19%) patients required one adjusting manoeuvre and 46 (31%) patients required 2-4 adjusting manoeuvres before intubation was successful. There were 13 patients with potential or known airway problems. The lungs of all of these patients were ventilated easily and the trachea intubated using the ILMA. In 10 of 13 (77%) of these patients, no resistance was encountered and the trachea was intubated at the first attempt; three of 13 (23%) patients required one adjusting manoeuvre. Tracheal intubation required significantly fewer adjusting manoeuvres in patients with a predicted or known difficult airway (P < 0.05). We conclude that the ILMA appeared on initial assessment to be an effective ventilatory device and intubation guide for routine and difficult airway patients not at risk of gastric aspiration.
Subject(s)
Laryngeal Masks , Adult , Aged , Aged, 80 and over , Anesthesia, General , Contraindications , Equipment Design , Female , Humans , Intubation, Intratracheal/methods , Male , Middle AgedABSTRACT
A new prototype of the laryngeal mask airway (LMA), the intubating laryngeal mask airway (ILMA), was used to facilitate tracheal intubation in 100 fasted patients presenting for elective surgery. Alignment of the ILMA with the larynx was assessed fibreoptically before intubation without the investigator performing the intubation being aware of the view score. Ease of intubation correlated with the view obtained and with the degree of manipulation of the ILMA needed to achieve tracheal intubation. Intubation was successful in 93 patients. Of the seven intubation failures, five occurred in the first 20 patients. Conventional connection to the breathing system and ventilation of the lungs of the patients were possible throughout the intubation procedure.
