The laryngeal mask airway: its role in the difficult airway.

The laryngeal mask airway (LMA) is a relatively new device that was brought into clinical practice in the 1980s. It was conceived, designed, and developed between 1981 and 1988 by Dr. Archie Brain, a British anesthesiologist who felt that a component for airway management was missing. The laryngeal mask was conceived to provide the bridge between the face mask and the endotracheal tube. The concept was that this mask would fill the niche, both anatomically and physiologically, between the two. The LMA would be more invasive than a face mask but less invasive than an endotracheal tube. Although Brain originally introduced the LMA as a general airway device, he was immediately aware that it would have some use in the management of difficult airways. In his pilot study published in 1983, he reported on the successful use of the LMA in 23 patients. Two of these patients had anatomy suggestive of a difficult intubation and “neither presented difficulty with regard to insertion of the LMA.” He concluded, “the LMA would appear to be of particular value where difficulty is experienced in maintaining the airway.” The LMA proved to be a simple device that was easy to teach, and easy to learn, how to use. Multiple series in both adult patients and pediatric patients detailed the ease of its use. 3 The device quickly spread throughout the anesthesia community. It is relatively noninvasive and can be placed both rapidly and easily. Given these facts, it is not surprising that case reports detailing its successful use in difficult airways began to grow. In 1985, only 2 years after his original study, Brain reported on three cases of difficult intubation in which the LMA was successfully used. This included one patient who was unexpectedly difficult to intubate and ventilate. The success of the LMA is probably due to two salient features: it performs adequately even when it is used poorly and allows for airway control and ventilation without affecting the function of the larynx. This