Laryngeal Mask Airway

imagesRescue airway when unable to intubate or difficult ventilation via bag-valve mask (BVM)


imagesFacilitate endotracheal intubation


CONTRAINDICATIONS



imagesAbsolute (When Used as an Airway Rescue Device): Ability to establish definitive airway with endotracheal intubation


imagesRelative Contraindications


   imagesHigh risk of aspiration


      imagesVomiting


      imagesMassive hemoptysis or brisk upper gastrointestinal bleeding


   imagesTrismus


   imagesLaryngeal injuries or tracheal disruption


   imagesRecent head and neck radiation


   imagesSignificant upper airway infection such as epiglottitis


   imagesForeign body in upper airway


   imagesConditions requiring high ventilation pressures (poor pulmonary compliance or increased airway resistance)


LANDMARKS



imagesInsert into oropharynx and advance until mask rests over glottic opening



imagesGeneral Basic Steps


   imagesChoose appropriate laryngeal mask airway (LMA) size


   imagesDeflate and lubricate mask


   imagesInsert along palate


   imagesInflate cuff


   imagesConfirm placement


   imagesSecure in place


TECHNIQUE—STANDARD LARYNGEAL MASK AIRWAY



imagesPreparation


   imagesConfirm all monitoring equipment is in place and functional, including oxygen saturation probe and cardiac telemetry


   imagesSelect appropriate LMA size based on estimated patient weight (TABLE 7.1)


   imagesAssess cuff for air leaks


      imagesInject appropriate amount of air for the selected LMA (Table 7.1)


      imagesDeflate while pressing cuff against a flat surface to provide a smooth leading edge for insertion


   imagesApply water-soluble lubricant to distal cuff surface


imagesPreoxygenation


   imagesDeliver 100% oxygen via nonrebreather mask or BVM ventilation


   imagesAdminister medications, such as sedatives, if needed










TABLE 7.1.


GUIDELINES FOR LARYNGEAL MASK AIRWAY SELECTION AND MASK INFLATION



images


imagesPosition


   imagesUse nondominant hand to adjust head position


   imagesSniffing position is optimal for nonintubating LMAs


   imagesMay maintain neutral head position if cervical spine immobilization is necessary


imagesPlacement


   imagesHold LMA in dominant hand like a pencil with index finger placed on airway tube at the tube–mask junction (FIGURE 7.1)


   imagesOpen airway with nondominant hand


   imagesInsert into oropharynx with aperture facing the tongue (FIGURE 7.2A)


   imagesPressing against the hard palate, advance past the posterior border of the tongue


   imagesResistance will be noted when the mask rests over the glottic opening (FIGURE 7.2B)


   imagesComplete insertion by using fingers to push LMA further into the supraglottic region (FIGURE 7.2C)


   imagesInflate collar—the increased size will cause LMA to move slightly out of mouth


   imagesConfirm successful ventilation with end-tidal carbon dioxide (ETCO2) detector and lung auscultation


imagesProtection


   imagesSecure LMA with tape or tube-securing device



images


FIGURE 7.1 Correct position of the fingers for LMA insertion. From Murphy FM. Extraglottic devices. In: Walls RM, Murphy MF, eds. Manual of Emergency Airway Management. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012:113–138.

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Laryngeal Mask Airway

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