The Intubating Laryngeal Mask Airway (ILMA) was introduced into clinical practice in 1997 following numerous clinical trials involving 1110 patients. The success rate of blind intubation via the device after two attempts is 88% in "routine" cases. Successful intubation in a variety of difficult airway scenarios, including awake intubation, has been described, with the overall success rate in the 377 patients reported being approximately 98%. The use of the ILMA by the novice operator has also been investigated with conflicting reports as to its suitability for emergency intubation in this setting. Blind versus visualized intubation techniques have also been investigated. These techniques may provide some benefits in improved safety and success rates, although the evidence is not definitive. The use of a visualizing technique is recommended, especially whilst experience with intubation via the ILMA is being gained. The risk of oesophageal intubation is reported as 5% and one death has been described secondary to the complications of oesophageal perforation during blind intubation. Morbidity described with the use of the ILMA includes sore throat, hoarse voice and epiglottic oedema. Haemodynamic changes associated with intubation via the ILMA are of minimal clinical consequence. The ILMA is a valuable adjunct to the airway management armamentarium, especially in cases of difficult airway management. Success with the device is more likely if the head of the patient is maintained in the neutral position, when the operator has practised at least 20 previous insertions and when the accompanying lubricated armoured tube is used.

The use of nitro-vasodilators for achieving rapid uterine relaxation in the resolution of obstetric emergencies has been documented for nearly 120 years. Glyceryltrinitrate (GTN) is the most commonly used nitro-vasodilator for this purpose, with the presumed mechanism of action being via nitric oxide and cyclic guanosine monophosphate (cGMP) mediated processes. GTN is known to release nitric oxide to effect smooth muscle relaxation and some dose response data is available for its vasodilator activity. Human myometrium is known to synthesize and respond to nitric oxide, with changes in the production of and sensitivity to nitric oxide being subject to the cyclical and gestational state of the uterus. Experimental data on the efficacy of GTN in reliably producing uterine relaxation is conflicting and inconsistent. A total of 32 studies and case reports on the use of GTN in achieving rapid uterine relaxation have appeared in the English language literature. Case reports are subject to reporting bias and prospective randomized controlled trials are not without design flaws. Indications for the use of GTN in achieving rapid uterine relaxation cover the antepartum, intrapartum and postpartum periods. The safety of GTN during obstetric emergencies appears high, with no adverse maternal or neonatal outcomes. To establish the efficacy of GTN in reliably achieving uterine relaxation, well designed randomized controlled trials in labouring women are required.

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