The laryngeal mask airway in obstetrical anaesthesia

Abstract

The laryngeal mask airway (LMA) has been used extensively to provide a safe airway in spontaneously breathing patients who are not at risk from aspiration of gastric contents. The role of the LMA in the event of a failed intubation in an obstetrical patient, and its place in a failed intubation drill remains unclear. Two hundred and fifty consultant obstetric anaesthetists in the United Kingdom were asked to complete an anonymous questionnaire regarding their views about using the laryngeal mask airway (LMA) in obstetrical anaesthesia. The LMA was available in 91.4% of obstetric units. Seventy-two per cent of anaesthetists were in favour of using the LMA to maintain oxygenation when tracheal intubation had failed and ventilation using a face mask was inadequate. Twenty-four respondents had had personal experience with the LMA in obstetrical anaesthesia, eight of whom stated that the LMA had proved to be a lifesaver. We believe that the LMA has a role in obstetrical anaesthesia when tracheal intubation has failed and ventilation using a face mask proves to be impossible, and it should be inserted before attempting cricothyroidectomy.

The laryngeal mask airway is effectièe (and probably safe) in selected healthy parturients for electièe Cesarean section: a prospectièe study of 1067 cases

“…2 9 Gature et al 5 reported the successful use of the LMA in 21/24 patients for failed intubation in obstetrics. In some of these patients the LMA was used as an airway intubator.…”

“…3 The current standard of practice for airway management of patients undergoing Cesarean section is to perform a rapid sequence induction followed by laryngoscope-guided tracheal intubation to protect the airway and facilitate ventilation. 4 The use of the LMA for Cesarean section has been limited to failed 5 or awake intubation 6 because of the perceived risk of aspiration and/or the need for positive pressure ventilation in the presence of high intraabdominal pressure. However, the risk of aspiration without tracheal intubation may have been overestimated in the obstetric population.…”

“…7 Furthermore, the incidence of aspiration with the LMA for elective surgery is similar to that with tracheal intubation, 8 reflux is rare with the LMA even in at risk patients, 3 and the LMA has provided adequate ventilation in situations where intraabdominal pressure is raised such as pneumoperitoneum, 1 obesity 9 and failed intubation in obstetric patients. 5 The LMA also offers potential advantages over the tracheal tube for elective patients in terms of hemodynamic responses, pulmonary physiology, emergence and postoperative airway morbidity. 10 In the following prospective study, we describe the use of the LMA for elective Cesarean section in 1067 healthy, selected patients.…”

Management of the difficult and failed airway in obstetric anesthesia

“…Case reports have described the successful use of the LMA and ILMA in the failed obstetric intubation with cannot intubate, cannot ventilate situation [60][61][62][63][64]. In a survey of obstetric anesthesia consultants in the United Kingdom, 72% of the respondents stated that they would use the LMA in the cannot intubate, cannot ventilate obstetric airway, and the survey suggested that the LMA was available in 91% of obstetric units [65]. Twenty four (of 250) consultant anesthetists had personal experience with the use of the LMA in obstetric anesthesia.…”

Airway problems in pregnancy

“…In a survey in the United Kingdom, 71.8% of obstetrical anesthesiologists advocated use of LMA in a CVCI situation. Eight anesthesiologists stated that LMA proved to be a 'lifesaver' (69). Recently, 18 obstetrics units in Ireland were surveyed for difficult airway equipment.…”