Neonatal and paediatric fibre-optic laryngoscopy and bronchoscopy using the laryngeal mask airway

1997 ◽  
Vol 111 (4) ◽  
pp. 349-353 ◽  
Author(s):  
A. E. Hinton ◽  
J. M. O'Connell ◽  
J. P. Van Besouw ◽  
M. E. Wyatt
Keyword(s):  
Laryngeal Mask Airway ◽  
Vascular Ring ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Fibre Optic ◽  
Upper Airways ◽  
Vocal Fold Paresis ◽  
Endoscopic View ◽  
Laryngeal Inlet ◽  
Neonates And Infants

AbstractEndoscopy of the upper airways in neonates and infants has traditionally been accomplished using rigid laryngoscopes and bronchoscopes. The laryngeal mask may be used both to control the airway for anaesthetic ventilation and to guide a fibre-optic endoscope to the laryngeal inlet and beyond.We report our experience with five neonatal and paediatric cases where fibre-optic laryngoscopy and bronchoscopy were performed through the laryngeal mask airway. All were cases in which standard rigid endoscopy had proved difficult with only a poor and restricted view of the laryngeal inlet being obtained due to the age of the infants, or abnormal anatomy of the upper airways.No problems have been encountered with maintenance of the airway or with the endoscopic view obtained. In fact in neonatal patients, this technique has been found to be preferable with regard to safety and ease of use when compared to the ventilating bronchoscope. With the size 1 laryngeal mask airway it is not possible to simultaneously ventilate and endoscope the patient. Cases included, a vascular ring, Goldenhar's syndrome, laryngomalacia, supraglottis and vocal fold paresis.This technique provides a secure method of maintaining anaesthetic ventilation during airway endoscopy, and also a means of easily locating the glottis.

A new diagnostic approach to congenital stridor using a laryngeal mask airway and rigid endoscope

1994 ◽  
Vol 108 (12) ◽  
pp. 1076-1077 ◽  
Author(s):  
A. Samet ◽  
Y. Talmon ◽  
R. Frankel ◽  
K. Simon
Keyword(s):  
Laryngeal Mask Airway ◽  
Laryngeal Mask ◽  
Diagnostic Approach ◽  
Fibre Optic ◽  
Diagnostic Problem ◽  
Rigid Endoscope

AbstractNeonates with symptoms of stridor from birth, present a difficult diagnostic problem. We have demonstrated that by the use of a laryngeal mask airway in an anaesthetized baby breathing spontaneously, we are able to reach a diagnosis. This is accomplished by the introduction of a rigid fibre-optic endoscope through a Portex swivel connector and visualizing the glottis and larynx.

The Glottic Aperture Seal Airway 

1998 ◽  
Vol 88 (5) ◽  
pp. 1219-1226 ◽  
Author(s):  
Jonathan L. Benumof
Keyword(s):  
Laryngeal Mask Airway ◽  
Control Device ◽  
Laryngeal Mask ◽  
Posterior Surface ◽  
Balloon Inflation ◽  
Proximal Half ◽  
Laryngeal Inlet ◽  
Airway Devices ◽  
Ventilatory Device ◽  
Ventilation Hole

Background None of the presently used airway devices are ideal regarding ease of insertion, alignment with the laryngeal inlet, and provision of a high-pressure seal from the environment. The purpose of this study was to determine, in awake volunteers, the performance of a new ventilatory device, the glottic aperture seal airway, regarding ease of insertion, alignment with the laryngeal inlet, and forced exhalation seal pressure (PFES). Methods The glottic aperture seal airway consists of a curved tubular component that ends in the middle of an elliptical foam cushion glottic component. The posterior surface of the foam has a curved flexible plastic backing, which imparts a 60 degree angle between the proximal half and the distal half of the foam cushion. When the glottic aperture seal airway is properly in situ in a supine patient, the proximal half of the foam cushion is opposite the laryngeal inlet. The posterior surface of the plastic backing has a balloon attached to it. Inflation of the balloon presses the ventilation hole and foam cushion up against the laryngeal inlet, thereby creating a seal from the environment. Using the laryngeal mask airway as a control device, the glottic aperture seal airway was tested for time and ease of insertion, fiberoptic alignment with the laryngeal inlet, and PFES in 18 lightly sedated and locally anesthetized volunteers. Results The glottic aperture seal and laryngeal mask airways were inserted with equal ease and speed. The fiberoptic alignment with the larynx was excellent for both the glottic aperture seal and laryngeal mask airways. In all volunteers, the mean +/- SD PFES values at 0-, 10-, 20-, 30-, and 40-ml balloon inflation volumes of the glottic aperture seal airway were 23.4 +/- 11.8, 29.6 +/- 12.4, 42.7 +/- 12.5, 56.9 +/- 5.6, and 60 +/- 0 cm H2O, respectively; the PFES at > or = 20 ml balloon inflation volume of the glottic aperture seal airway was significantly greater than with the laryngeal mask airway (19.4 +/- 6.7 cm H2O, P < 0.01). A PFES of > or =60 cm H2O was achieved with the glottic aperture seal airway in all volunteers (n = 2 at 10 ml, n = 3 at 20 ml, n = 9 at 30 ml, and n = 4 at 40 ml). The glottic aperture seal airway did not cause any trauma. Conclusion In awake volunteers, the glottic aperture seal and laryngeal mask airways were equally easy to insert and position. The glottic aperture seal airway was capable of achieving a higher PFES than the laryngeal mask airway.

scholarly journals Comparison of I-gel with Classic Laryngeal Mask Airway Regarding the Ease of Use and Clinical Performance

2015 ◽  
Vol 43 (5) ◽  
pp. 299-303 ◽  
Author(s):  
Dilek Erdogan Ari ◽  
Arzu Yildirim Ar ◽  
Ceren Sanlı Karip ◽  
İncifer Siyahkoc ◽  
Ahmet Hakan Arslan ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Clinical Performance ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Classic Laryngeal Mask Airway

scholarly journals Unilateral Vocal Cord Paralysis following Insertion of a Supreme Laryngeal Mask in a Patient withSjögren’sSyndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
T. O. J. Masarwa ◽  
I. H. F. Herold ◽  
M. Tabor ◽  
R. A. Bouwman
Keyword(s):  
Laryngeal Mask Airway ◽  
Airway Management ◽  
Vocal Cord ◽  
Endotracheal Intubation ◽  
Vocal Cord Paralysis ◽  
Case Reports ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Less Invasive ◽  
Unilateral Vocal Cord Paralysis

Since its introduction in 1988 by Dr. Archie Brain, the laryngeal mask airway (LMA) is being used with increasing frequency. Its ease of use has made it a very popular device in airway management and compared to endotracheal intubation it is less invasive. The use of LMA was on the rise, so has been the incidence of its related complications. We report severe unilateral vocal cord paralysis following the use of the supreme laryngeal mask (sLMA) in a patient withSjögren’ssyndrome. In addition, we propose possible mechanisms of injury, review the existing case reports, and discuss our findings.

A Randomized Controlled Trial Comparing the Cuffed Oropharyngeal Airway and the Laryngeal Mask Airway in Spontaneously Breathing Anesthetized Adults 

1998 ◽  
Vol 88 (4) ◽  
pp. 970-977 ◽  
Author(s):  
Robert S. Greenberg ◽  
Joseph MB Brimacombe ◽  
Alison Berry ◽  
Victoria Gouze ◽  
Steven Piantadosi ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Controlled Trial ◽  
Head Tilt ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Oropharyngeal Airway ◽  
Average Total Number ◽  
Spontaneously Breathing ◽  
First Time ◽  
Better Than

Background The cuffed oropharyngeal airway (COPA), a modified Guedel airway, was compared with the laryngeal mask airway (LMA) during spontaneous breathing anesthesia. Specifically examined were ease of use, physiologic tolerance, and the frequency of problems. Methods Adult patients consented to random (2:1) assignment to either COPA (n = 302) or LMA (n = 151) for airway management during anesthesia with propofol, nitrous oxide, and oxygen. Results Ease of insertion was similar, but the first-time successful insertion rate was higher with the LMA (COPA, 81% compared with LMA, 89%; P = 0.05). More brief manipulations (head tilt, chin lift, jaw thrust) were reported in the COPA group (average total number of manipulations: COPA, 1.1 +/- 1.6 compared with LMA, 0.1 +/- 0.2; P < 0.001). Continuous airway support was used more frequently in the COPA group (COPA, 30% compared with LMA, 0%; P < 0.0005). The incidences of aspiration, regurgitation, laryngospasm, wheezing, succinylcholine administration, oxygen saturation (SpO2) < 92%, failed use, and minor intraoperative problems were similar. When the airways were removed, blood was detected on the COPA less frequently than on the LMA (COPA, 5.8% compared with LMA, 15.3%; P = 0.001). The incidence of early and late sore throat was greater with the LMA (early: COPA, 4.7% compared with LMA, 21.9% [P = 0.001]; late: COPA, 8.4% compared with LMA, 16.1%; P = 0.01). The LMA did better than the COPA when anesthetists analyzed the technical aspects of the two devices. Conclusions Although the COPA and LMA are equivalent devices in terms of physiologic alterations and overall clinical problems associated with their use, the LMA was associated with a higher first-time insertion rate and fewer manipulations, suggesting that it is easier to use. The COPA was associated with less blood on the device and fewer sore throats, suggesting it may cause less pharyngeal trauma. Ultimately, both devices were similar in establishing a safe and effective airway for spontaneously breathing anesthetized adults.

scholarly journals Comparison of Efficacy of Laryngeal Mask Airway and Intersurgical-Gel Supraglottic Airway Device During General Anesthesia in a Tertiary Care Hospital

2019 ◽  
Vol 8 (3) ◽  
pp. 151-155
Author(s):  
Muhammad Saqib Butt ◽  
Noor Un Nisa ◽  
Ghulam Mustafa ◽  
Hasham Khan
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Hemodynamic Response ◽  
Airway Device ◽  
Laryngeal Mask ◽  
Supraglottic Airway ◽  
Care Hospital ◽  
Upper Airways ◽  
Group A ◽  
Group B

Background: Upper airways collapse during anesthesia is a common issue faced by anesthetists. Air way maintenance is an essential component of general anesthesia. Laryngeal mask airway and Intersurgical-gel (i-gel) air way devices are new advances in general anesthesia. Present study aims to compare the ease of insertion and hemodynamic response of i-gel supraglottic and laryngeal mask airway (LMA). Material and Methods: A Randomized Clinical trial was conducted at the Department of Anesthesia, Shaikh Zayed Hospital, Lahore. Study duration was 6 months (June 2014- December 2014). A total of 60 patients were selected through non-probability consecutive sampling. Ethical approval was taken from ethical review board of Sheikh Zayed Hospital and informed written consents were taken from all the participants. Patients were randomly divided into two groups using lottery method. Group A was given laryngeal mask airway device while group B patients were provided with i-gel supraglottic device during anesthesia. Patients were compared for ease of insertion and hemodynamic parameters. Data was analyzed using SPSS version 24. Chi-square and t-test were applied and p-value ≤0.05 was considered statistically significant. Results: A total of 60 patients were included in study. Mean age of patients was 35.2±11.7 years in LMA group and 36.7±13 years in i-gel group. Group B had lower number of insertion attempts (p=0.01) and high insertion satisfaction (p=0.4) as compared to group A. However, process failure and bleeding rate was found to be slightly higher in group B (16% and 13% respectively) as compared to group A (p>0.05). Conclusion: i-gel supraglottic device is a successful alternative option in terms of ease of insertion and less hemodynamic response as compared to laryngeal mask airway during general anesthesia. Key words: , , 

How do different brands of size 1 laryngeal mask airway compare with face mask ventilation in a dedicated laryngeal mask airway teaching manikin?

2017 ◽  
Vol 103 (3) ◽  
pp. F271-F276 ◽  
Author(s):  
Mark Brian Tracy ◽  
Archana Priyadarshi ◽  
Dimple Goel ◽  
Krista Lowe ◽  
Jacqueline Huvanandana ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Peak Inspiratory Pressure ◽  
Face Mask ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Mask Ventilation ◽  
Resuscitation Guidelines ◽  
Bag Mask Ventilation

BackgroundInternational neonatal resuscitation guidelines recommend the use of laryngeal mask airway (LMA) with newborn infants (≥34 weeks’ gestation or >2 kg weight) when bag-mask ventilation (BMV) or tracheal intubation is unsuccessful. Previous publications do not allow broad LMA device comparison.ObjectiveTo compare delivered ventilation of seven brands of size 1 LMA devices with two brands of face mask using self-inflating bag (SIB).Design40 experienced neonatal staff provided inflation cycles using SIB with positive end expiratory pressure (PEEP) (5 cmH2O) to a specialised newborn/infant training manikin randomised for each LMA and face mask. All subjects received prior education in LMA insertion and BMV.Results12 415 recorded inflations for LMAs and face masks were analysed. Leak detected was lowest with i-gel brand, with a mean of 5.7% compared with face mask (triangular 42.7, round 35.7) and other LMAs (45.5–65.4) (p<0.001). Peak inspiratory pressure was higher with i-gel, with a mean of 28.9 cmH2O compared with face mask (triangular 22.8, round 25.8) and other LMAs (14.3–22.0) (p<0.001). PEEP was higher with i-gel, with a mean of 5.1 cmH2O compared with face mask (triangular 3.0, round 3.6) and other LMAs (0.6–2.6) (p<0.001). In contrast to other LMAs examined, i-gel had no insertion failures and all users found i-gel easy to use.ConclusionThis study has shown dramatic performance differences in delivered ventilation, mask leak and ease of use among seven different brands of LMA tested in a manikin model. This coupled with no partial or complete insertion failures and ease of use suggests i-gel LMA may have an expanded role with newborn resuscitation as a primary resuscitation device.

scholarly journals Evaluation of prehospital insertion of the laryngeal mask airway by primary care paramedics with only classroom mannequin training

CJEM ◽  
2002 ◽  
Vol 4 (05) ◽  
pp. 338-343 ◽  
Author(s):  
Michael J. Murray ◽  
Marian J. Vermeulen ◽  
Laurie J. Morrison ◽  
Tim Waite
Keyword(s):  
Primary Care ◽  
Cardiac Arrest ◽  
Laryngeal Mask Airway ◽  
Success Rate ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Suitable Alternative ◽  
Traumatic Cardiac Arrest

ABSTRACT: Introduction: The laryngeal mask airway (LMA™ airway) provides adequate ventilation and offers a suitable alternative for airway management in patients with cardiac arrest if primary care paramedics do not have intubation skills or are unable to intubate. Training in the use of the LMA usually occurs in the operating room. Objective: To describe the use of the LMA by paramedics in prehospital adult non-traumatic cardiac arrest patients after classroom mannequin training. The study took place in a suburban rural emergency medical service. Methods: This is a 2-phase observational study of the effect of paramedic training for LMA insertion using a mannequin and the success rate in the prehospital setting. All paramedics successfully completed classroom mannequin training. All subsequent prehospital adult non-traumatic cardiac arrest patients from mid-February 1999 to Mar. 31, 2000, were eligible. Subjective assessment of chest expansion, ease of ventilation and auscultation defined adequacy of ventilation. Data collected included the number of insertion attempts, reasons for failure, ease of insertion, adverse events and reasons for not attempting intubation. Statistical analysis comprised descriptive frequencies, chi-squared tests for comparison of categorical variables and analysis of variance for continuous variables. Results: 208 paramedics (100%) successfully completed training. The mean number of attempts was 1, and only 4 (2.1%) paramedics required a second attempt with a mannequin. The paramedics’ perception of ease of use comparing the LMA with a bag valve mask (BVM) was evenly distributed across the 3 descriptors: 70 (39%) scored the LMA as easier to use, 57 (31%) as more difficult, and 54 (30%) stated there would be no difference. Of the 291 arrests during the study period, insertion of the LMA was attempted in 283 (97.3%) and was successful in 199 (70%) patients. The LMA became dislodged in 5 (2.5%) cases and was removed in 12 (6%) to clear vomit from the airway. The overall success rate was 182 (64%). The incidence of regurgitation prior to attempted insertion of the LMA was 28% (79 patients). Success rates did not vary significantly with the incidence of vomiting prior to insertion (p = 0.11). The majority of the paramedics evaluated LMA insertion as Very easy 49/220 (22.3%) or Easy 87/220 (39.6%). Paramedic evaluation of ease of use varied with success (p = 0.001). Conclusions: This study reports a 100% training success rate with a mannequin and a 64% success with LMA insertion and ventilation in the field by paramedics among adult out-of-hospital non-traumatic cardiac arrest patients.

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