1. History of LMA

2. Life before the Laryngeal Mask Airway (LMA)

3. Life before the Laryngeal Mask Airway (LMA)
Options for Ventilation
Previous methods
Bag Mask Ventilation
Endotracheal intubation

4. The Development of the LMA
In 1981 Dr. Brain began the development of The Laryngeal Mask Airway (LMA™) in London.
His interest in the human airway led him to make plaster of Paris casts of a cadaver pharynx.
When administering dental anaesthesia Dr. Brain noticed the similarity between the Goldman dental nasal mask cuff and the available size and space in the pharynx as defined by his plaster of Paris moulds.

5. The Development of the LMA
The first prototype of the LMA™ airway, was to incorporate a 10 mm plastic tube into the floor of the mask.
Brain noted that an airtight seal could be achieved around the laryngeal inlet by inflating the cuff in the hypopharynx.

6. The Development of the LMA
After 7 years of developments, the first LMA was commercially available in Britain in 1988.
Key developments:
Silicone mask prototypes improved the smoothness of insertion.
Wafer-thin leading edge when fully deflated making collision with the epiglottis less likely.
Successful insertion required a specific technique and the use of an introducer tool was discontinued.

7. Armstrong Laryngeal Airways
La Premier Plus

8. The Development of the LMA
“And some questions just won’t go away: should I have tried to insist on the comparison with the physiology of swallowing, involving as it did the development and teaching of an insertion technique which as it turned out very few were ever to understand, let alone master? The insertion tool would have done the trick, but my diaries remind me that it was removed just after the LMA was launched to avoid the risk of possible trauma”
Dr Brain 2003 Dublin

9. The Development of the LMA
Dr Brain mentions an Insertion technique comparative with the physiology of swallowing.

11. Review of Laryngeal Airways
Original insertion technique
1. Deflate, Shape & Lubricate.

12. Review of Laryngeal Airways
Original insertion technique
2. Pen Technique.

13. Review of Laryngeal Airways
Original insertion technique
3. Flatten cuff unto hard palette.

14. Review of Laryngeal Airways
Original insertion technique
4. Maintain pressure and insert until resistance is felt.

15. Review of Laryngeal Airways
Original insertion technique
5. Use free hand to maintain pressure while removing index finger.

16. Review of Laryngeal Airways
Original insertion technique
6. Do not hold mask while inflating, only “inflate to seal”.

17. Review of Laryngeal Airways
Airway in place

18. Review of Laryngeal Airways
When correctly shaped and Inserted the cuff mimics a bolus of food which sits in the hypopharynx.
When inflated it covers the laryngeal inlet.
Lies at the cross roads of the respiratory and digestive tracts

19. Review of Laryngeal Airways
Benefits of LMA:
Brings airflow closer to the source.
Avoids placement beyond the vocal cords.
Provides a reliable seal to deliver airflow to larynx without filling the esophagus.
Quick insertion.

20. Review of Laryngeal Airways
Advantages:
Hands free
No Laryngoscopy
Quick
Disadvantages:
Pressure leaks
Risk of gastric aspiration
High cuff pressures

21. Review of Laryngeal Airways
Wrong technique, the reasons
The LMA has revolutionized airway management in Anesthesia.
Since the expiry of the LMA patent many new manufacturers have entered the market, few of which have offered any education or training.
In this vacuum many bad habits have developed and the key principles which made the LMA such a success have been lost.

22. Review of Laryngeal Airways
Wrong technique
Wrong technique: Problem: Response
Under sizing: Leaks: Over inflate cuff
No deflation: Folding tip: Leak: Over inflate
Deflation without shaping: Trauma: Insert partially inflated
No Lubrication: Trauma: Blame the product
No Pressure onto hard pallet: Folding tip: Leaks: overinflate cuff
No fingers in mouth: facilitated by stiffer shafts
Over inflation: Unaware

23. Review of Laryngeal Airways
Airway in place

24. Review of Laryngeal Airways
History of La Premier & La Premier Plus
2002 expiry of original patent.
2003 Armstrong source a Silicone Airway from China.
,000 La Premier units sold in Ireland work commences on La Premier +.
2009 Launch of La Premier plus mk1.
2010 Enhancements to La Premier plus.

25. “HEAR WHAT YOU SAY & SEE/FEEL WHAT YOU MEAN”
Can you make your customer
“HEAR WHAT YOU SAY & SEE/FEEL WHAT YOU MEAN”

26. Armstrong Laryngeal Airways
La Premier Plus
Armstrong Laryngeal Airways

27. Armstrong Laryngeal Airways
La Premier Plus
Armstrong Laryngeal Airways

28. Armstrong Laryngeal Airways