The laryngeal mask airway (LMA) is used widely in the operating
room for airway management during anesthesia, but is also recognized
as a “rescue” technique in emergency airway management.
An LMA is a wide bore airway with a standard tube connector at one
end (Figure 26-1) and a cuffed, (inverted) teardrop- shaped distal
end (Figures 26-2 and 26-3) designed to sit over the larynx with
the cuff inflated (Figure 26-4), thereby isolating the airway from
the esophagus and oropharynx and preventing aspiration.
LMA and syringe to inflate cuff.
Laryngeal mask with teardrop shape, cuff deflated and
showing fenestrated air passage.
Graphic showing LMA cuff in correct position covering
- ▪ Mask: Inverted teardrop shaped concave mask with central
fenestrations to tube and a circumferential compliant cuff designed
to seal the mask against the larynx with a low-pressure seal
- ▪ Tube: The tubular conduit of the LMA between the mask and
- ▪ Intubating LMA: A special variant of the LMA designed to
facilitate emergency ventilation and airway management, followed
by bronchoscopy and passage of a standard endotracheal tube through
the LMA and over the bronchoscope
Techniques for Laryngeal Mask Airway Insertion
- ▪ Indications for the use of an LMA in emergency airway
- —For emergency ventilation when mask ventilation is
unsuccessful (ie, in the patient with a difficult airway)
- —Emergency airway access when endotracheal
intubation is unsuccessful
- —Conduit for fiberoptic intubation
- ▪ Preparation: Prior to LMA insertion, the universal
protocol (Chapter 3) should be performed including timeout, consent,
and equipment setup
- —Equipment: Ensure the availability and functioning
of all required equipment including:
- • Oxygen source
- • Functioning suction circuit
- • Large bore (ie, Yankauer) suction device during
- • Selection of appropriately sized LMA tubes with
competent cuffs (where relevant)
- • Self-inflating ventilation bag with attached oxygen
- • Selection of face masks
- • Selection of oral and nasal airways
- • Pulse oximeter to monitor patient oxygenation
- • End-tidal CO2 detector to determine
correct tube placement following procedure
- • Bronchoscope and endotracheal tubes if LMA insertion
is intended as a temporizing measure prior to endotracheal intubation
- • Mechanical ventilator (while a mechanical ventilator
is not necessary for performance of the procedure, most patients
will be placed on a mechanical ventilator immediately following
- • Ensure the availability of skilled assistance
during performance of procedure including respiratory therapist, ...
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