Laryngeal mask
The laryngeal mask or laryngeal mask ( synonyms : laryngeal , " laryngeal mask airway ," Brain Airway , Brain -Tubus, named after the British Brain, who has the laryngeal mask in 1983 first described) is a means to hold open the airways in unconscious patients, for example, during an anesthetic . It was developed by the English anesthetist Archibald Brain from 1981 and introduced into clinical practice. It consists of a body (made of silicone, for example) with an inflatable cuff and a tube (made of plastic, for example), at the end of which it can be connected to a ventilation unit, which enables spontaneous breathing with an increased percentage of oxygen or manual or mechanical ventilation. In Germany, the larynx mask has been approved for anesthesia as a replacement for the face mask since 1991. They are available in different sizes 1 to 5, which can be used from newborns to large adults.
Advantages, application profile
Compared to the face mask, it has the advantage of better sealing the upper airways. In addition, the anesthetist has both hands free. In contrast to endotracheal intubation , there is no need to place an endotracheal tube past the vocal cords in the windpipe . The laryngeal mask is pushed just over the larynx into the lower part of the throat and sealed there with an inflatable air bead. Typical complications of intubation such as hoarseness or injuries from the laryngoscope are largely avoided when the laryngeal mask is used. The laryngeal mask is therefore mostly used for shorter interventions in the fasting patient. In addition, however, it is also firmly integrated into algorithms for difficult airway management and is used (in addition to alternatives such as the laryngeal tube or combitubus ) when bag-mask ventilation and endotracheal intubation are unsuccessful.
Limitations and Side Effects
As with the face mask, there is a general risk of aspiration (inhalation) of stomach contents during anesthesia with the larynx mask because the trachea and esophagus are not separated. In addition, ventilation with excessive pressure can inflate the stomach.
A not uncommon side effect after using the laryngeal mask is a sore throat in the patient caused by the foreign body in the throat. If the insufflation pressure of the air cushion is too high and if it is used for a long time, the mucous membrane of the throat and the nerves running in the surrounding soft tissues can be damaged.
Modifications
The laryngeal mask originally developed by Archibald "Archie" Ian Jeremy Brain (* 1942) has been modified several times. In addition to the reusable laryngeal mask, laryngeal masks are single-use as well as devices with additional channels through which a gastric tube can be inserted.
The intubation laryngeal mask (ILMA) allows the subsequent insertion of an endotracheal tube through the already inserted mask and is used in difficult intubation conditions. In this way, intubation can take place in patients who are already anesthetized and ventilated in a controlled manner. If the subsequent intubation does not succeed, the ILMA can still be used to ventilate the patient.
literature
- AIJ Brain: The laryngeal mask - a new concept in airway management. In: British Journal of Anaethesiology. Vol. 55, 1983, pp. 801-805.
- Walied Abdulla: Interdisciplinary Intensive Care Medicine. Urban & Fischer, Munich a. a. 1999, ISBN 3-437-41410-0 , p. 9.
- T. Asai, S. Morris: The laryngeal mask airway: its features, effects and role. In: Can J Anesthesiol. 41, 1994, pp. 930-960. PMID 8001213
- Archibald Brain, WT Denman, NG Goudsouzian: Laryngeal Mask Airway Instruction Manual. LMA North America Inc, San Diego, Calif 1999.
- R. Brimacombe, AIJ Brain, A. Berry: The Laryngeal Mask Airway: A Review and Practice Guide. Saunders, Philadelphia, Pa 1997, pp. 216-277.
- TM Cook, G. Lee, JP Nolan. The ProSeal laryngeal mask airway: a review of the literature. In: Can J Anaesth. 52 (7), Aug / Sep 2005, pp. 739-760. Review. PMID 16103390
- O. Langeron, J. Amour, B. Vivien, F. Aubrun: Clinical review: management of difficult airways. In: Crit Care. 10 (6), 2006, p. 243. Review. PMID 17184555
