The laryngeal mask airway. Safety, efficacy, and current use

In 1983, the laryngeal mask airway (LMA) was introduced as a new airway device. It can be inserted without the aid of a laryngoscope or neuromuscular blockade. Compared with the face mask, the LMA allows for a more "hands-free approach" to airway management providing the anesthesiologist the freedom of not holding a mask. In addition, the LMA is more effective than the face mask, with or without a Guedel airway, during emergency resuscitation in situations where endotracheal intubation is difficult or not possible. The LMA seems to provide better oxygenation than the face mask; but unlike the endotracheal tube, it does not protect the airway from aspiration of gastric contents if regurgitation occurs. For this reason, it is believed that the LMA should not be used in place of an endotracheal tube during emergency rescue, but rather as an adjunct to airway management prior to intubation. It is possible that the risk of regurgitation with or without aspiration may be minimized if proper screening of patients is employed prior to use of the LMA. The current literature concerning its safety and efficacy is reviewed.