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What is a laryngeal mask? In what types of operations is it placed on the patient? What are the indications and contraindications for this anesthesia device? Insights from anesthesiologist Laure Martinat.
Laryngeal mask: definition
“The laryngeal mask is an anesthesia device used by healthcare professionals – anesthesiologists – to resuscitate the ventilation of patients under general anesthesia”, defines Laure Martinat, anesthesiologist. It was developed by Doctor Brain in the 1980s
A supraglottic device
The laryngeal mask is “a ventilatory device that is also called supraglottic device because he has the peculiarity of not passing between the vocal cords unlike the other device used in general anesthesia called the intubation tube.distinguishes the anesthesiologist.
Use and installation of the laryngeal mask
Why wear a laryngeal mask?
The laryngeal mask, like the intubation tube, are therefore two reserved devices exclusively for general anesthesiathat is to say operations where the patient is completely asleep and requires to be connected to a machine (a ventilator or respirator) to breathe.
What are the differences between the tube and the laryngeal mask?
“The intubation tube is a tube, a small pipe, which is slipped through the patients' mouth and which passes through the vocal cords”explains Dr. Martinat. “The laryngeal mask also passes through the mouth, it looks like a large lollipop with its handle and its hole at the end which will remain above what we call the glottis, that is to say -say above the vocal cords”, she continues. To find out more about fitting a laryngeal mask, do not hesitate to consult the explanatory video from the MDS Manuel medical reference site.
Laryngeal mask or intubation tube?
Why use a laryngeal mask before anesthesia rather than a catheter?
The advantage of this device? He is less invasive than the intubation tube, since it does not pass between the vocal cords. The laryngeal mask is therefore better tolerated by patients. Indeed, “it causes less pain in the throat post-operatively, it carries no risk of injury to the vocal cordswhich can be the case on an intubation tube”, specifies Laure Martinat. And our expert adds that “the use of the laryngeal mask also causes a lot less risk of tooth breakageunlike the probe with which there is always a risk of damaging a tooth in passing..
Laryngeal mask: indications
There will be both criteria depending on the patient and criteria depending on the type of surgery performed. If all the criteria are met, health professionals favor the use of the laryngeal mask over the intubation tube, because it is less invasive, better tolerated by patients, and there is less risk of complications. The probe irritates the throat a little and can hurt the patient between 24 and 48 hours after the operation.
Laryngeal mask for short-term surgery
The use of this device is exclusively reserved for short-term surgeries (maximum two hours). Indeed, statistically, there is a risk that the device ends up moving, no longer conforming perfectly to the patient's anatomy. Gold, “if we exceed a delay of two hours, we statistically increase the risk of leak, that is to say that the air passes a little by and the patient no longer benefits from appropriate ventilation”underlines the anesthesiologist.
Laryngeal mask only in fasting patients
“The patient must also be perfectly on an empty stomach, at least for six hours without having eaten or drunk in order to avoid any risk of regurgitation”also notes our expert.
Laryngeal mask possible in adults, children and newborns
As Dr. Martinat reports, “this device can use it in adults and children alike. (including baby and newborn). The size of the mask will then be larger or smaller depending on the age of the patient.
Laryngeal mask: contraindications
Laryngeal mask and curares
The laryngeal mask cannot be used only for “surgeries for which we do not need to use drugs from the curare family”, warns the specialist. These are medications to achieve muscle relaxation. If the patient is taking medical treatment of this type, we will then use the intubation tube to ventilate him during general anesthesia.
Facial trauma
Furthermore, the laryngeal mask is not usable only on a patient who has not had facial trauma (of the face). “A road accident victim who has suffered facial trauma will not be able to have a laryngeal mask”underlines Laure Martinat.
Non-fasting patient
A patient who has suffered an accident requiring emergency treatment will not necessarily have been able to respect the 6-hour time limit without drinking or eating. “The non-guarantee of fasting constitutes a contraindication to the laryngeal mask, we will be obliged to use the probe, otherwise there would be a risk of inhalation, that is to say that the patient vomits and that it passes into the lungs”, indicates the anesthesiologist. And for good reason, she warns, “When gastric fluid is sucked into the lungs, this is called aspiration pneumonia, it is very serious and can even lead to the death of the patient.”
Gastroesophageal reflux and hiatal hernia
We will also not put a mask on a patient suffering from a lot of reflux gastro-oesophagiens or a hiatal hernia (malformation of the stomach and lower part of the esophagus). These are disorders, very common pathologies which promote reflux.
Bariatric surgery
Quite common case also preventing the installation of a laryngeal mask: patients who have undergone a bariatric surgery (obesity surgery). In these former obese patients, the digestive tract has been modified and they are no longer allowed to have a laryngeal mask. Indeed, “they are, by definition, at risk of vomiting at the start of anesthesia, that is to say during the falling asleep phase called induction”notes Dr. Martinat.
Laryngeal mask: possible complications
The main risk of fitting a laryngeal mask is therefore, as the anesthesiologist explained, that the patient vomits, has reflux and that this goes back to the lungs with the risk of causing aspiration pneumonia. Fortunately, the risk of regurgitation is very rare, and in particular because health professionals ensure that the patient does not have treatment containing curares, suffers from reflux, facial trauma and is fasting. .