Multiple applications of the laryngeal mask airway

The laryngeal mask was successfully developed and used clinically in the mid-1980s and introduced in China in the 1990s. Great progress has been made in the use of the laryngeal mask and its application is becoming increasingly widespread.

Firstly, the use of laryngeal mask airway in the dental field. Unlike most medical surgeries, dental procedures typically impinge upon the airway. In North America, approximately 60% of dentist anesthesiologists do not routinely intubate, which clearly identifies variance in practice (Young AS, 2018). Airway management is a topic of interest because the loss of airway reflexes associated with GA can lead to significant airway complications ( Divatia JV, 2005). A systematic search of electronic databases and gray literature was completed by Jordan Prince (2021). It was eventually concluded that the use of an LMA in dentistry may have the potential to reduce the risk of postoperative hypoxia.

Secondly, the use of laryngeal mask airway ventilation in surgeries to be performed in upper tracheal stenosis has been reported in the case series. Celik A (2021) analysed the records of 21 patients who underwent tracheal surgery using LMA ventilation between March 2016 and May 2020 were evaluated retrospectively. It was eventually concluded that LMA-assisted tracheal surgery is a method that can be used safely as a standard technique in the surgery of benign and malignant diseases of both the upper and lower airway performed on pediatric patients, patients with tracheostomy, and suitable patients with tracheoesophageal fistula.

Thirdly, the second-line use of LMA in the management of the obstetric airway. The obstetric airway is a significant cause of maternal morbidity and mortality (McKeen DM, 2011). Endotracheal intubation is considered the standard of care but the laryngeal mask airway (LMA) has gained acceptance as a rescue airway and has been incorporated into the obstetric airway management guidelines. Wei Yu Yao (2019) compared the Supreme LMA (SLMA) with endotracheal intubation (ETT) in managing the obstetric airway during cesarean section and found that LMA could be an alternative airway management technique for a carefully selected low-risk obstetric population, with similar insertion success rates, reduced time to ventilation and less hemodynamic changes compared with ETT.

References
[1]Young AS, Fischer MW, Lang NS, Cooke MR. Practice patterns of dentist anesthesiologists in North America. Anesth Prog . 2018;65(1):9–15. doi: 10.2344/anpr-64-04-11.
[2]Prince J, Goertzen C, Zanjir M, Wong M, Azarpazhooh A. Airway Complications in Intubated Versus Laryngeal Mask Airway-Managed Dentistry: A Meta-Analysis. Anesth Prog. 2021 Dec 1;68(4):193-205. doi: 10.2344/anpr-68-04-02. PMID: 34911069; PMCID: PMC8674849.
[3]Celik A, Sayan M, Kankoc A, Tombul I, Kurul IC, Tastepe AI. Various Uses of Laryngeal Mask Airway during Tracheal Surgery. Thorac Cardiovasc Surg. 2021 Dec;69(8):764-768. doi: 10.1055/s-0041-1724103. Epub 2021 Mar 19. PMID: 33742428.
[4] Rahman K, Jenkins JG. Failed tracheal intubation in obstetrics: no more frequent but still managed badly. Anaesthesia. 2005;60:168–171. doi: 10.1111/j.1365-2044.2004.04069.x.
[5]Yao WY, Li SY, Yuan YJ, Tan HS, Han NR, Sultana R, Assam PN, Sia AT, Sng BL. Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial. BMC Anesthesiol. 2019 Jul 8;19(1):123. doi: 10.1186/s12871-019-0792-9. PMID: 31286883; PMCID: PMC6615212.