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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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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,
nurse to monitor patient during performance of procedure and ...