LARYNGEAL MASK AIRWAY (LMA) INSERTION
The laryngeal mask airway (LMA) is a supraglottic airway device that provides an alternative to endotracheal intubation (ET). It is inserted into the oropharynx, creating a seal around the glottic opening.
ADVANTAGES OF LMA
- Easier insertion: The LMA is generally easier to insert than an ET tube, requiring less training and skill.
- Faster placement: LMA insertion can often be performed more quickly than ET intubation, which can be crucial in emergency situations.
- Less cervical spine movement: LMA insertion requires less manipulation of the cervical spine compared to ET intubation, making it a safer option for patients with suspected cervical spine injuries.
DISADVANTAGES OF LMA
- Less airway protection: The LMA does not provide the same level of airway protection against aspiration as an ET tube.
- Limited use in certain situations: The LMA is not suitable for patients requiring high airway pressures (e.g., in cases of severe lung disease) or for patients with a full stomach (due to the increased risk of aspiration).
INDICATIONS FOR LMA INSERTION
- Difficult or failed endotracheal intubation.
- Short-term airway management during surgery or procedures.
- Emergency airway management when tracheal intubation is not immediately feasible.
CONTRAINDICATIONS FOR LMA INSERTION
- Patients at high risk of aspiration (e.g., patients with a full stomach, pregnant patients).
- Patients requiring high airway pressures.
- Patients with significant facial or upper airway trauma.
LMA INSERTION TECHNIQUE
- Preparation: Select the appropriate size LMA based on the patient’s weight. Inflate the cuff to check for leaks. Deflate the cuff completely before insertion.
- Positioning: Position the patient’s head in a neutral or slightly sniffing position.
- Insertion: Hold the LMA like a pen, with the opening facing the patient’s hard palate. Insert the LMA into the mouth, following the natural curve of the palate.
- Advancement: Advance the LMA until resistance is met.
- Inflation: Inflate the cuff with the appropriate volume of air.
- Confirmation of Placement: Confirm placement by observing chest rise with ventilation, auscultating breath sounds, and using capnography.
CONFIRMATION OF PLACEMENT
As with ET intubation, confirming proper placement is essential. Use a combination of:
- Auscultation of breath sounds.
- Observation of chest rise.
- Capnography (the most reliable method).
The LMA is a valuable tool in airway management, especially in situations where ET intubation is difficult or not possible. However, it is important to understand its limitations and contraindications.