Laryngeal mask & other oro and nasophargeal apparatus . Done by : Wael abu-anzeh

Laryngeal mask

The laryngeal mask was invented by British anaesthesiologist/anaesthetist Archie Brain in the early 1980s and in December 1987 the first commercial laryngeal mask was made available in the United Kingdom A laryngeal mask airway (LMA) : is a medical device that keeps a patient's airway open during anaesthesia or unconsciousness. It is a type of supraglottic airway(unlike tracheal tubes which pass through the glottis). used by paramedics and anaesthetists A laryngeal mask has an airway tube that connects to an elliptical mask with a cuff(inflatable). Once inserted correctly the mask conforms to the anatomy with the bowl of the mask facing the space between the vocal cords. After correct insertion, the tip of the laryngeal mask sits in the throat against the muscular valve that is located at the upper portion of the oesophagus.

Technique for insertion of the standard LMA The patient’s reflexes must be suppressed to a level similar to that required for the insertion of an oropharyngeal airway to prevent coughing or laryngospasm :- The cuff is deflated and the mask lightly lubricated(the posterior surface). A head tilt is performed(hyperextension of the neck), the patient’s mouth opened fully and the tip of the mask inserted along the hard palate with the open side facing but not touching the tongue The mask is further inserted, using the index finger to provide support for the tube. Eventually, resistance will be felt at the point where the tip of the mask lies at the upper oesophageal sphincter The cuff is now fully inflated using an air-filled syringe attached to the valve at the end of the pilot tube

Advantages of the LMA It is not affected by the shape of the patient’s face or the absence of teeth. The anaesthetist is not required to hold it in position, avoiding fatigue and allowing any other problems to be dealt with. It significantly reduces the risk of aspiration of regurgitated gastric contents, but does not eliminate it completely Its use is relatively contraindicated where there is an increased risk of regurgitation, for example in emergency cases, pregnancy and patients with a hiatus hernia The LMA has proved to be a valuable aid in those patients who are difficult to intubate, as it can usually be inserted to facilitate oxygenation while additional help or equipment is obtained

Oropharngeal airway Also known as an oral airway, OPA or Guedel airway To maintain the airway in the unconscious patient by preventing the tongue from falling back into the pharynx An estimate of the size required measure from angle of mouth to ear( or the jaw angle). Inserted upside down until the tip is beyond the end of the tongue> rotated 180 degrees into position At all times the patient's airway is maintained by the hand not holding the device: holding the mouth open and jaw forward The device is removed when the person regains gag reflex and can protect their own airway. Simply remove by pulling on it without rotation Can facilitate ventilation during CPR (cardiopulmonary resuscitation) and for persons with a large tongue

NASOPHARYNGEAL AIRWAY nasal trumpet

used on conscious victims since it is better tolerated because it generally does not stimulate the gag reflex. The purpose of the flared end is to prevent the device from becoming lost inside the patient's nose A guide to the correct size is made by comparing the diameter to the external nares(*The common sizes in adults are 6–8 mm). The diameter of the airway should be the largest that will fit. Prior to insertion, the patency of the nostril (usually the right) should be checked Since it is made of flexible material, it is designed to be lubricated and then gently passed up the nostril and down into the pharynx

Contraindication of NPA in-patients with severe trauma to the head and/or face due to the possibility of direct intrusion into brain tissue. If an obstruction is encountered, do not force the airway as severe bleeding may be provoked. The airway should be removed and inserted in the left nostril

Simple manual manoeuvres to overcome airway obstruction