History of LMA

Life before the Laryngeal Mask Airway (LMA)

 Life before the Laryngeal Mask Airway (LMA)

Options for Ventilation

Previous methods
Bag Mask Ventilation
Endotracheal intubation
 The Development of the LMA

In 1981 Dr. Brain began the development of The Laryngeal Mask Airway (LMA) in
London.
His interest in the human airway led him to make plaster of Paris casts of a cadaver
pharynx.
When administering dental anaesthesia Dr. Brain noticed the similarity between the
Goldman dental nasal mask cuff and the available size and space in the pharynx as
defined by his plaster of Paris moulds.
 The Development of the LMA

The first prototype of the LMA airway, was to incorporate a 10 mm plastic tube into
the floor of the mask.
Brain noted that an airtight seal could be achieved around the laryngeal inlet by
inflating the cuff in the hypopharynx.
 The Development of the LMA

After 7 years of developments, the first LMA was commercially available in Britain in
1988.
Key developments:
Silicone mask prototypes improved the smoothness of insertion.
Wafer-thin leading edge when fully deflated making collision with the epiglottis less likely.
Successful insertion required a specific technique and the use of an introducer tool was
discontinued.
 La Premier Plus
Armstrong Laryngeal Airways
 The Development of the LMA

And some questions just wont go away: should I

have tried to insist on the comparison with the
physiology of swallowing, involving as it did the
development and teaching of an insertion
technique which as it turned out very few were
ever to understand, let alone master? The insertion
tool would have done the trick, but my diaries
remind me that it was removed just after the LMA
was launched to avoid the risk of possible trauma
Dr Brain 2003 Dublin
 The Development of the LMA

Dr Brain mentions an Insertion technique comparative with the physiology of

swallowing.
 Review of Laryngeal Airways
Original insertion technique

1. Deflate, Shape & Lubricate.

 Review of Laryngeal Airways
Original insertion technique

2. Pen Technique.
 Review of Laryngeal Airways
Original insertion technique

3. Flatten cuff unto hard palette.

 Review of Laryngeal Airways
Original insertion technique

4. Maintain pressure and insert until resistance is felt.

 Review of Laryngeal Airways
Original insertion technique

5. Use free hand to maintain pressure while removing index finger.

 Review of Laryngeal Airways
Original insertion technique

6. Do not hold mask while inflating, only inflate to seal.

Review of Laryngeal Airways
Airway in place
 Review of Laryngeal Airways

When correctly shaped and Inserted the cuff mimics a bolus of food which sits in the
hypopharynx.
When inflated it covers the laryngeal inlet.
Lies at the cross roads of the respiratory and digestive tracts
 Review of Laryngeal Airways

Benefits of LMA:
Brings airflow closer to the source.
Avoids placement beyond the vocal cords.
Provides a reliable seal to deliver airflow to larynx without filling the esophagus.
Quick insertion.
 Review of Laryngeal Airways

Advantages:
Hands free
No Laryngoscopy
Quick
Disadvantages:
Pressure leaks
Risk of gastric aspiration
High cuff pressures
 Review of Laryngeal Airways
Wrong technique, the reasons

The LMA has revolutionized airway management in Anesthesia.

Since the expiry of the LMA patent many new manufacturers have entered the
market, few of which have offered any education or training.
In this vacuum many bad habits have developed and the key principles which made
the LMA such a success have been lost.
 Review of Laryngeal Airways
Wrong technique

Wrong technique: Problem: Response

Under sizing: Leaks: Over inflate cuff
No deflation: Folding tip: Leak: Over inflate
Deflation without shaping: Trauma: Insert partially inflated
No Lubrication: Trauma: Blame the product
No Pressure onto hard pallet: Folding tip: Leaks: overinflate cuff
No fingers in mouth: facilitated by stiffer shafts
Over inflation: Unaware
Review of Laryngeal Airways
Airway in place
 Review of Laryngeal Airways
History of La Premier & La Premier Plus

2002 expiry of original patent.

2003 Armstrong source a Silicone Airway from China.
2007 60,000 La Premier units sold in Ireland work commences on La Premier +.
2009 Launch of La Premier plus mk1.
2010 Enhancements to La Premier plus.
Can you make your customer

HEAR WHAT YOU SAY & SEE/FEEL WHAT YOU MEAN

 La Premier Plus

Armstrong Laryngeal Airways

 La Premier Plus

Armstrong Laryngeal Airways

Armstrong Laryngeal Airways