THE LARYNGEAL MASK AS AN INSTRUMENT

The laryngeal mask (LM) was developed by A. Brain to overcome the disa dvantages of the face mask (impractical) and the tracheal tube (invasi ve). Today this new instrument is applied on a braod scale in Great Br itain and with growing interest in continental Europe. The laryngeal m ask comes in five sizes to fit five different age groups. The blindly applied technique of positioning the LM can be easily learned. Spontan eous or artificial ventilation is possible if the LM is in the correct position. Mechanical ventilation may lead to the insufflation of air into the stomach. Therefore, ventilatory peak pressure should not exce ed 20-25 cm H2O and ventilation must be closely monitored. The risk of aspiration can be avoided by the proper selection of patients. The LM may be used with different anaesthetic techniques; muscle relaxant dr ugs are not mandatory. The authors have applied this mask more than 30 00 times, and this new instrument obviously has potential for differen t clinical indications. The LM may be applied for short surgical inter ventions in all age groups except premature infants. Complications suc h as regurgitation, aspiration and laryngospasm can be avoided by the awareness of the anaesthetist and by an adjusted deep plane of anaesth esia. Apart from anaesthesia, the LM can be used for bronchoscopy in c hildren, for difficult intubations and as a preliminary airway in case s of resuscitation. Two studies performed in Great Britain have evalua ted the LM for resuscitation. The investigations should be confirmed i n German-speaking countries.