Nasal laryngeal mask airway (NLMA)

This novel innovation is the world’s first commercial nasal laryngeal mask. It allows good surgical access for dental, maxillofacial, ear nose and throat, head and neck surgery.

BENEFITS OF THE NASAL LARYNGEAL MASK INCLUDE:

Laryngeal masks are easier to insert compared to endotracheal tubes.

Airway is first secured with an oral flexible reinforced LMA before nasal intubation.

Airway and ventilation is maintained throughout procedure.

Complications are minimised as:

The airway is first secured orally before nasal intubation.

The introducer and flexible reinforced airway tubing used for nasal intubation are recognised to reduce complications of nasal intubation.

The flexible reinforced endotracheal tube allows nasal intubation through the lower safer nasal passage.

Airway is more secure using a nasal LMA compared to the use of an oral LMA for oral surgical procedures.

Well tolerated and may be removed in recovery room improving operating room efficiency

Use of a LMA compared to Endotracheal intubation results in reduced:

post operative nausea and vomiting

post operative sore throat

coughing on emergence

haemodynamic instability

anaesthetic requirements

recovery time for day surgery

CONTRAINDICATIONS:

Suspected base of skull fractures

Bleeding diathesis

Patients with an aspiration risk

OUR NASAL LARYNGEAL MASK AIRWAY IS PRESENTED AS A PACK CONTAINING:

Flexible reinforced laryngeal mask airway with a removable 15 mm ISO connector.

Flexible reinforced airway tubing having a fixed 15 mm ISO connector and a connector to mate to an Introducer.

Introducer.

METHOD OF USE

ORAL TO NASAL LARYNGEAL MASK

A flexible reinforced oral laryngeal mask is used to secure the airway. Anaesthesia is maintained and the patient ventilated.

The distal end of the flexible reinforced airway tubing having the same diameters of the airway tubing of the laryngeal mask with a standard 15mm connector at the proximal end is connected with a smooth, tapered, curved and blunt ended introducer is passed through the most patent nostril. The Introducer and is grasped and delivered through the mouth with Magill’s forceps and once approximately 5cm of the airway tubing protrudes from the lips the introducer is removed.

The anaesthetic circuit is now removed from the oral laryngeal mask and connected to the proximal end of the nasal airway tubing. The 15mm connecter is removed from the oral laryngeal mask airway tubing and joined to the distal end of the airway tubing protruding through the mouth. This allows for continued patient ventilation and maintained anaesthesia.

The airway tubing of the laryngeal mask is stabilized in the oro-pharynx and the redundant airway tubing of the joined laryngeal mask and nasal airway tubing is reduced by gentle traction on the nasal airway tubing distal to the nares.

Once satisfied that the laryngeal mask is in the correct position and ventilation is maintained the nasal airway tubing is disconnected from the laryngeal mask tubing and the 15mm connector is reinserted in the laryngeal mask airway tubing and reconnected to the airway circuit. The original oral laryngeal mask is now reconfigured as a nasal laryngeal mask.

The pilot balloon and tubing may be stored in the mouth if necessary.

NASAL TO ORAL LARYNGEAL MASK

The anaesthetic circuit is removed from the nasal laryngeal mask and the 15mm connector is removed from the distal end. The anaesthetic circuit is connected to the proximal nasal airway tubing and the distal end of this tube is connected to the laryngeal mask tubing allowing continued ventilation and anaesthesia.

The proximal end of the laryngeal mask airway tubing connected to the body of the laryngeal mask is stabilized in the oro-pharynx while the airway tubing distal to the nares is gently pushed back through the naso-pharynx and the redundant tubing is delivered through the mouth. When the connection between the laryngeal mask and nasal tubing is visualised it is disconnected and the 15mm connector reinserted into laryngeal mask tubing and connected to the anaesthetic circuit. The Nasal laryngeal mask is now reconfigured as the original oral laryngeal mask.

SIZES BASED ON STANDARD LMA CUFF SIZES:

Size 5 – ID 8.5mm                 Size 5 – ID 8mm

Size 4 – ID 8mm                    Size 4 – ID 7.5mm

Size 3 – ID 7.5mm                 Size 3 – ID 7mm

Size 2.5 – ID 6.5mm              Size 2.5 – ID 6mm

Size 2 – ID 5.5mm