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

 Facilitate endotracheal intubation

CONTRAINDICATIONS

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

 Relative Contraindications

    High risk of aspiration

       Vomiting

       Massive hemoptysis or brisk upper gastrointestinal bleeding

    Trismus

    Laryngeal injuries or tracheal disruption

    Recent head and neck radiation

    Significant upper airway infection such as epiglottitis

    Foreign body in upper airway

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

LANDMARKS

 Insert into oropharynx and advance until mask rests over glottic opening

TECHNIQUE—STANDARD LARYNGEAL MASK AIRWAY

 Preparation

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

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

    Assess cuff for air leaks

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

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

    Apply water-soluble lubricant to distal cuff surface

 Preoxygenation

    Deliver 100% oxygen via nonrebreather mask or BVM ventilation

    Administer medications, such as sedatives, if needed

 Position

    Use nondominant hand to adjust head position

    Sniffing position is optimal for nonintubating LMAs

    May maintain neutral head position if cervical spine immobilization is necessary

 Placement

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

    Open airway with nondominant hand

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

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

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

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

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

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

 Protection

    Secure LMA with tape or tube-securing device

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