Laryngeal Mask Airway Insertion
The laryngeal mask airway (LMA) is used to establish and maintain a patent airway in the unconscious patient. It’s used extensively in the operating room by anesthesia personnel and is also appropriate for emergency airway and ventilatory support when endotracheal (ET) intubation isn’t immediately possible. The LMA may also be used in place of a face mask during adult, pediatric, and neonatal resuscitation.1,2,3
The LMA consists of a semirigid tube attached to a silicone mask. The mask is placed into the patient’s mouth and advanced blindly until it rests above the larynx. The patient may then breathe spontaneously or be assisted with moderate positive-pressure ventilation.
The LMA doesn’t always protect the patient from regurgitation and aspiration, so it should be used in patients with full stomachs only in emergency situations in which intubation isn’t possible, or if ventilation by face mask is ineffective. However, regurgitation is less likely and aspiration uncommon with the LMA when compared with the bag-mask device.1 In addition, the LMA should only be inserted into the patient who has lost protective cough and gag reflexes. The LMA should be used cautiously in patients with delayed gastric emptying because of the risk of regurgitation.
Types of LMAs used outside of the operating room include reusable (requiring cleaning and sterilization between uses) and disposable (for single-patient use). An intubating LMA is also available; it’s used to provide a patent airway, which facilitates ET intubation.
Occasionally, patients can’t be adequately ventilated with the LMA, even after successful insertion; ET intubation supplies should be readily available, if needed.1
Equipment
Appropriately sized LMA based on patient’s weight (reusable, disposable, or intubating) (see LMA specifications, page 452) ▪ syringe of appropriate size for inflating cuff ▪ water-soluble lubricant ▪ gloves and other personal protective equipment ▪ oxygen equipment ▪ tape or device to secure the tube ▪ bag-valve mask device ▪ bite block ▪ stethoscope ▪ suction equipment ▪ pulse oximeter, if available ▪ capnometer.
Preparation of Equipment
Perform hand hygiene thoroughly to reduce the transmission of microorganisms.4,5,6 While the equipment is being prepared, ventilate and oxygenate the patient with a bag-valve or mouth-to-mouth mask device, if necessary. Remove the LMA from its package and visually inspect it for discoloration, cracks, or kinks in the tube; also make sure it’s the right size. Inspect the airway opening and check that the aperture bars are intact. Manually tighten the connector, if needed.
Test the patency of the cuff by first withdrawing all air and then overinflating it with air injected through the pilot balloon. While inflated, visually inspect the cuff for symmetry; then deflate the cuff. Don’t use the LMA if it’s leaking air or if you note that the cuff is asymmetrical when you inflate it. Assemble suction equipment and check that it’s working properly.
Implementation
If this is a planned procedure, verify the order in the patient’s medical record to ensure that the right procedure is being performed on the right patient at the right time.7
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.8
Lma Specifications
The following chart will help you choose the right size laryngeal mask airway (LMA) for your patient.
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