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Introduction

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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.

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Figure 26-1.
Graphic Jump Location

LMA and syringe to inflate cuff.

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Figure 26-2.
Graphic Jump Location

Laryngeal mask with teardrop shape, cuff deflated and showing fenestrated air passage.

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Figure 26-3.
Graphic Jump Location

LMA with inflated cuff.

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Figure 26-4.
Graphic Jump Location

Graphic showing LMA cuff in correct position covering tracheal inlet.

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Definitions and Terms

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  • ▪  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 the connector
  • ▪  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

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Techniques for Laryngeal Mask Airway Insertion

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  • ▪  Indications for the use of an LMA in emergency airway management
    • —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 procedure
      • • Selection of appropriately sized LMA tubes with competent cuffs (where relevant)
      • • Self-inflating ventilation bag with attached oxygen feed
      • • Selection of face masks
      • • Selection of oral and nasal airways
      • • Pulse oximeter to monitor patient oxygenation during procedure
      • • 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 intubation)
    • —Personnel
      • • Ensure the availability of skilled assistance during performance of procedure including respiratory therapist, ...

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