In: Dental treatment12 Nov 2009
Any health care professional can be faced with a medical emergency in which the patient may require ventilatory support. One of the most important considerations during resuscitation, as well as in the provision of general anesthesia, is the delivery of oxygen to the lungs. The most common indication for airway intervention is unconsciousness, during which the airway is frequently obstructed by the base of the tongue falling into the posterior oropharynx and hypopharynx. The main problems associated with difficult airway include brain injury, myocardial injury, airway trauma, and death.
Maintaining ventilation with an oropharyngeal airway and bag-valve-mask device, while maintaining head tilt-chin lift and jaw thrust, is tiring and often ineffective when attempted by dentists inexperienced in airway management (Figure 1).
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Figure 1. Intubating model with oropharyngeal airway and bag-valve-mask device. О indicates oropharyngeal airway; F, face mask; and L, laryngeal inlet.
Most commercially available nasopharyngeal airways have been shown to be shorter than the optimal length and can cause severe bleeding when inserted. Endotracheal intubation is the gold standard for securing a patent airway. It is, however, a difficult skill to acquire and requires regular practice to maintain proficiency. Endotracheal intubation usually requires direct laryngoscopy, which may cause problems such as dental or laryngopharyngeal trauma, sore throat, and even loss of voice. Endotracheal intubation requires not only an endotracheal tube, but also equipment such as a laryngoscope, pharyngeal suction, and a stethoscope (or some other means of confirming intubation), which adds to the cost and amount of equipment required.
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Figure 2. Laryngeal mask airway (LM) slightly retracted to show the laryngeal inlet (L).
The laryngeal mask airway (LMA) (Laryngeal Mask Co, Nicosia, Cyprus), shown in Figure 2, was developed in 1983 and is a device that frequently provides a patent airway for resuscitation or anesthetic delivery in both adults and children. It is inserted blindly, with a low incidence of airway trauma, into the hypopharynx and forms a low-pressure seal around the laryngeal inlet. There are 2 main components to the device. The first is a shaft that varies in diameter according to the size of the LMA and is fitted at one end with a standard anesthesia connector device. Fused to the distal end of the shaft at a 30° angle is an elliptical, inflatable rim (cuff). The distal aperture that faces the laryngeal inlet has 2 bars that prevent the epiglottis from falling back and obstructing its lumen. The tip of the mask cannot pass beyond the esophageal sphincter, and hence esophageal intubation is not possible.
In the operating room, the LMA has been shown to prevent laryngotracheal airway soiling in dental procedures for adults and children and in other upper airway surgical procedures such as intranasal surgery. In the emergency situation, once the LMA is inserted, the resuscitator is free to use both hands to squeeze the ventilation bag.
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The purpose of this study was to determine whether a short and simple period of training would increase the speed and accuracy of placement of the LMA by dental students with little formal airway management experience.
Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.