[The laryngeal mask as an instrument]

The laryngeal mask (LM) was developed by A. Brain to overcome the disadvantages of the face mask (impractical) and the tracheal tube (invasive). Today this new instrument is applied on a broad scale in Great Britain and with growing interest in continental Europe. The laryngeal mask comes in five sizes to fit five different age groups. The blindly applied technique of positioning the LM can be easily learned. Spontaneous or artificial ventilation is possible if the LM is in the correct position. Mechanical ventilation may lead to the insufflation of air into the stomach. Therefore, ventilatory peak pressure should not exceed 20-25 cm H2O and ventilation must be closely monitored. The risk of aspiration can be avoided by the proper selection of patients. The LM may be used with different anaesthetic techniques; muscle relaxant drugs are not mandatory. The authors have applied this mask more than 300 times, and this new instrument obviously has potential for different clinical indications. The LM may be applied for short surgical interventions in all age groups except premature infants. Complications such as regurgitation, aspiration and laryngospasm can be avoided by the awareness of the anaesthetist and by an adjusted deep plane of anaesthesia. Apart from anaesthesia, the LM can be used for bronchoscopy in children, for difficult intubations and as a preliminary airway in cases of resuscitation. Two studies performed in Great Britain have evaluated the LM for resuscitation. The investigations should be confirmed in German-speaking countries.