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Reviews of Educational Material  |   September 2006
Laryngeal Mask Anesthesia: Principles and Practice, 2nd Edition.
Author Notes
  • The University of Chicago, Chicago, Illinois.
Article Information
Reviews of Educational Material / Airway Management
Reviews of Educational Material   |   September 2006
Laryngeal Mask Anesthesia: Principles and Practice, 2nd Edition.
Anesthesiology 9 2006, Vol.105, 636. doi:
Anesthesiology 9 2006, Vol.105, 636. doi:
Laryngeal Mask Anesthesia: Principles and Practice, 2nd Edition.  By Joseph R. Brimacombe, M.B., Ch.B., F.R.C.A., M.D. New York, Saunders, 2005. Pages: 699. Price: $125.00.
Archie Brain, M.A., F.F.A.R.C.S.I. (Honorary Consultant of Anesthesiology, Royal Berkshire Hospital, Reading, Great Britain), inventor of three distinctive types of Laryngeal Mask Airway  ™ (LMA  ™), has revolutionized airway management, especially that of the difficult airway. No other invention has had such a profound impact on the safe management of the airway and the practice of anesthesia in the past 50 yr. The introduction of the LMA  ™ in 1988 has generated tremendous interest in research in airway management, resulting in more than 4,000 publications. Because Joseph R. Brimacombe’s (Professor, James Cook University, Cairns, Australia) contribution to this body of literature is significant both in quantity (more than 400 articles) and in quality, he is highly qualified to write this textbook.
Chapter 1 covers the history of the development of extraglottic airways from 1874, the LMA  ™, a biography of its inventor, and the history of the LMA Company (Bucks, United Kingdom). Dr. Brain modified the first LMA  ™ many times and, with his close associate, Chandy Verghese, M.B.B.S., D.A., F.R.C.A., (Consultant in Anesthesia and Intensive Care Medicine, Royal Berkshire Hospital, Reading, Great Britain), used the device in more than 7,000 patients before he considered it safe for general use. The number of prototypes designed and the amount of work devoted to development of the device remind me of the efforts of Thomas Edison, who worked relentlessly to complete the first functional electric bulb 120 yr ago. The LMA  ™ is unique in the history of the inventions of airway devices. Mr. Robert Gaines-Cooper (Founder and Group Chairman, LMA Company, Osprey House, Old Street, St. Helier, Jersey, Channel Islands) had the business vision and trust in Dr. Brain to invest capital in a company solely for manufacturing and distributing the LMA  ™, at the time a device with an unknown future.
Dr. Brimacombe should be congratulated for the scope of this text, which raises the bar for future clinicians and scientists who intend to write evidence-based medical textbooks.
The book consists of an introduction and 22 chapters, and has many new features not seen in most other textbooks. The introduction describes the method for literature search, review, and summary. Whenever three or more studies addressed one particular issue, they were subjected to meta-analysis before summary statements and practice guidelines were offered. Each chapter starts with an index of contents and ends with a quick reference section, a summary, and a list of the meta-analytical findings. The references for each chapter are extensive, up-to-date, and described as peer reviewed, review paper, case report, abstract, or letter with or without data. In Chapter 13, “The Difficult Airway,” for example, most references include one to four lines of description about the type of study and the findings. Chapters 2 and 3 describe the family of LMA  ™ devices and accessories and the relevant pharyngeal and laryngeal anatomy. Chapter 4 reviews the pathophysiologic effects of the LMA  ™ on the body’s systems. Chapters 5 and 6 review the mechanism and clinical implications of LMAs  ™. Chapters 7–10 summarize the use of the LMA  ™ for administration of anesthesia: indications and contraindications, size selection, insertion techniques, assessment of function and position, and timing of removal. The techniques applied for use of the LMA  ™ are superbly illustrated. The use of the LMA  ™ in the intensive care unit and for resuscitation is summarized in Chapters 11 and 12. Chapter 13 examines the role of the LMA  ™ in management of the difficult airway. Chapters 14–19 consider the use of the LMA  ™ in children and in surgical specialties, and the flexible, intubating, and Pro-Seal LMAs  ™. Chapter 20 discusses the educational topics related to the use of the LMA  ™. Chapter 21 reviews the complications and problems associated with the use of LMA  ™. Finally, Chapter 22 presents other extraglottic devices and compares them with the LMA  ™. The book also has three appendices listing articles that appeared after the book was submitted to the publisher. These references are grouped by their relevance to the 22 chapters of the book. The third appendix lists the names of the researchers and the number of their publications about the LMA  ™. Most of the 4,299 researchers have published 9 or fewer articles; the textbook’s author has 412, more than anyone else.
Dr. Brimacombe emphasizes that the LMA  ™ is not just another airway device but rather a new approach to anesthetic management that has improved patient comfort and safety. The reader appreciates the author’s own contribution to this field, his selected and modified techniques in use of these devices, and his enormous personal contribution to the subject with the experience that he has gained over past 15 yr. The information offered in this textbook is complete.
Fortunately, the shortcomings of the book are few and insignificant. Reading page 162, under the heading Nasotracheal Intubation, I got the impression that nasotracheal intubation is performed using an LMA  ™. What is described is the use of the LMA  ™ in supporting fiberoptic nasotracheal intubation. The statement that the “LMA  ™ may be the airway of choice for thyroid surgery where the trachea is grossly deviated or narrowed as it may prevent further tracheal damage” (p. 420) is not shared by this reviewer. On page 540, line 9, the word “shorter” should be “longer.” Some of the endoscopic colored pictures could have been of a higher quality. These few criticisms, however, do not affect the value of the book.
Dr. Brimacombe has done a superb job in writing this textbook and has accomplished all the goals stated in the preface. This book is strongly recommended to those engaged in airway management and the practice of anesthesia. It offers rich practical and clinical information essential for safe use of the LMA  ™ and is an exceptional resource for clinicians and physician scientists interested in airway research. Dr. Brain’s innovation is a gift of life to patients and anesthesiologists alike and has saved an untold number of lives since its introduction. With this book, Dr. Brimacombe makes a convincing argument for the proper use of LMA  ™ to assure patient safety and well-being. It is unfortunate that the full clinical potential of LMA  ™ is not always realized.
This book is a testimonial to Dr. Brimacombe research achievements and his clinical expertise and, as stated in the preface, a tribute to Dr. Archie Brain’s legacy.
The University of Chicago, Chicago, Illinois.