Why laryngeal mask airway

Another area of controversy is LMA use in obese patients. Physiological changes seen in obese patients make them a challenging population, including a restrictive lung pattern due to abdominal contents limiting diaphragm motion and yielding less respiratory compliance.

LMA design has evolved and clinical use has expanded significantly in recent decades. Evidence suggests that LMA use is safe with mechanical ventilation in appropriately fasted patients while minimizing the inspiratory pressures applied.

Second-generation devices may minimize leak and limit gastric insufflation compared to first-generation LMAs. Muscle relaxant may be considered and has been shown to facilitate LMA insertion and mechanical ventilation. Use of LMA in obese patient remains controversial. Studies have proved successful ventilation of obese patients with a BMI below However, in patients with higher BMIs, ventilation may be impaired due to physiologic changes in obesity. The LMA should always be considered as a rescue device for difficult ventilation or intubation, regardless of patient size.

Appropriate LMA indications continue to be debated. It is important to recognize the potential complications and relative contraindications to the LMA and adjust a clinical algorithm, which would optimize the use of the LMA in airway management. Yong G. Newsletter The official journal of the anesthesia patient safety foundation. Summary: The article discusses the advancements of the laryngeal mask airway LMA and its routine and non-routine uses.

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Advertisement advertisement. At the proper distance of insertion as confirmed by markings on the tube , the mask will overlie the laryngeal opening, and the tip of the mask will meet at the esophageal opening definitive resistance to further insertion see figure Laryngeal mask airway Laryngeal Mask Airways LMA If no spontaneous respiration occurs after airway opening and no respiratory devices are available, rescue breathing mouth-to-mask or mouth-to-barrier device is started; mouth-to-mouth ventilation Inflate the cuff.

Use half the recommended maximum cuff volume. As the mask seats over the glottic area, the tube will protrude 1 to 2 cm out of the mouth. The LMA is a tube with an inflatable cuff that is inserted into the oropharynx. A: The deflated cuff is inserted into the mouth. B: With the index finger, the cuff is guided into place above the larynx. C: Once in place, the cuff is inflated. Do not over-inflate the cuff. Generally, start with half the maximal cuff volume and adjust as necessary.

Adjust the cuff volume. Try both lower and higher volumes a poor cuff seal may be caused by either too low or too high cuff volumes. Try a better configured sniffing position, a chin-to chest position, jaw thrust, or chin-lift maneuvers. Do the up-down maneuver. Withdraw the LMA 5 to 6 cm, without deflating the cuff, and then reinsert it to release an epiglottis trapped under the cuff or inside the mask. Deflate the cuff and remove the LMA.

Consider using another airway, such as an intubating laryngeal mask airway, King laryngeal tube, endotracheal intubation, or a surgical airway. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge.

This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Videos Figures Images Quizzes Symptoms. Additional Considerations.

Relevant Anatomy. Step-by-Step Description of Procedure. Warnings and Common Errors. Tips and Tricks. Test your knowledge. Prior to beginning tracheal intubation, it is important to first correctly position the patient, prepare the medical equipment, and do which of the following additional actions? More Content. Click here for Patient Education. LMAs are useful in situations where bag-valve-mask ventilation is difficult:.

Absolute contraindications. Maximum mouth opening between incisors. Impassable upper airway obstruction surgical airway would be indicated in this case. Consciousness or presence of a gag reflex patients should be unconscious or receive drugs to aid intubation Drugs to Aid Intubation Pulseless and apneic or severely obtunded patients can and should be intubated without pharmacologic assistance.

Complications include. Vomiting and aspiration. Gloves, mask, gown, and eye protection ie, universal precautions. Pulse oximeter, capnometer end-tidal carbon dioxide monitor , and appropriate sensors.

Optimal patient position for LMA insertion is the sniffing position. The sniffing position is used only in the absence of cervical spine injury:. Position the patient supine on the stretcher. Head and neck positioning to open the airway A: The head is flat on the stretcher; the airway is constricted. Inflate and deflate the cuff to check its volume and ensure that there are no leaks. Some newer cuffs use a gel that molds to the airway rather than an inflatable cuff.

To improve difficult or inadequate LMA ventilation:. Adjust patient positioning while doing bag-valve ventilation to help make ventilation easier. Rotate the LMA deeper into the hypopharynx and elevate the handle toward the ceiling. Was This Page Helpful?