Studies on the laryngeal mask: first, learn the art.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to A I Brain.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The history of the invention and development of the Laryngeal Mask in the East End of London during the years 1981-88 is briefly described. The concept evolved from home-made prototypes built from the Goldman Dental Mask through a complex series of one-off latex models culminating in a primitive factory-made silicone cuff in 1986. This work defined the design parameters necessary to reconcile the needs for safety, reliability and ease of insertion while at the same time exploring the limits to possible use. In early 1988 the final version was tested by the inventor who had by this time used the device in more than 7500 patients undergoing routine surgery. From this experience a number of important lessons were learned relating to safe and effective use, which are summarized in the inventor's Instruction Manual. The importance of referring to this volume before use is stressed.
The effect of electromagnetic stimulation on nerve conduction and on muscle contraction was studied in isolated frog sciatic nerve-gastrocnemius muscle preparation. The nerve trunk was passed through an induction copper coil and current was induced from a d.c. source 1.5-4 V at a frequency of 100 min-1, for 20-120 s duration, via an operating switch. Normal indirectly-elicited twitch (0.5 Hz with 0.6 V, supramaximal, and 1 ms pulse duration) tension was elicited, repetitively, and this was interrupted by magnetic induction. Inhibition of the twitch tension was taken as a measure of conduction block. The results showed that magnetic stimulation inhibited or blocked the twitch contractions (control 3.2 +/- 0.1 g, tension, mean +/- s.e., n = 8), in 4-5 min, and hence it blocked nerve conduction in this preparation. Recovery was achieved within 4-5 min, after washing out the preparation in Ringer solution. The mechanism of inhibition was interpreted in terms of an interference with ionic fluxes across the cell membrane. A comparison of electrical and magnetic stimulation was made and this was related to their clinical and experimental implications.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The effect of electromagnetic induction (EMI) on impulse conduction and muscle contraction was studied in isolated sciatic nerve-gastrocnemius muscle preparation of the frog. Electrical stimulation (ES) of the sciatic nerve, at 0.5 Hz with 0.6 V (supramaximal) and 1-ms pulse duration, produced twitch contractions (3.5 +/- 0.4 g tension, mean +/- S.E., n = 8 frogs), which were reduced or blocked by EMI, applied to the nerve via an induction coil, from a d.c. source of 1.5-4 V, at a frequency of 100 min-1, for 2- to 4-min duration. Recovery of the blocked twitches was obtained within 4-5 min, after the cessation of the EMI and washing out the preparation in Ringer solution. The inhibition of the twitch tension by EMI was compared to that produced by an effective concentration of a local anaesthetic, lignocaine (1 microM), which is known to block conduction, by blocking ionic fluxes across the nerve membrane. It is possible that EMI also interferes with the ionic fluxes, and in prolonged duration, may produce changes in the myelin sheath (or the Schwann cells) of the nerve membrane. A comparison of ES with EMI was made, and it was concluded that EMI inhibited electrically induced neuromuscular transmission at the frog neuromuscular junction.
Three cases of difficult intubation are described in which the problem was overcome by use of the laryngeal mask airway. It is stressed that the anaesthetist should become thoroughly familiar with the technique before attempting to use it in difficult cases.
A new form of airway has recently been described, which is introduced blindly into the hypopharynx to form a seal around the larynx, so permitting spontaneous or positive pressure ventilation without penetration of the larynx or oesophagus. The further development of this new airway is described and the results of 18 months' clinical experience are presented. The airway was used successfully in 118 patients, 17 of whom received controlled ventilation of their lungs. It was used in place of the facemask in routine anaesthesia, and was of particular value in ophthalmic, dental and ear, nose and throat procedures and where difficulties with the airway were expected. The incidence of sore throat and other problems was low. Experience of more than 500 cases suggests that the laryngeal mask airway may have a valuable rôle to play in all types of inhalational anaesthesia, while its proven value in some cases of difficult intubation indicates that it may contribute significantly to the safety of general anaesthesia.
Explore the source record for details and available documents.
A new type of airway is described, which may be used as an alternative to either the endotracheal tube or the face-mask with either spontaneous or positive pressure ventilation. The results of a pilot study involving 23 patients are presented and the possible merits and disadvantages of the device are discussed, bearing in mind that the study is of a preliminary nature.
Explore the source record for details and available documents.
This case illustrates that a new prototype laryngeal mask with high seal pressures can be placed in the awake patient with minimal cardiorespiratory changes and that it facilitates passage of a nasogastric tube.