Since its invention, the Laryngeal Mask Airway, or LMA, has become quite valuable as a surgical airway alternative to intubation. When I first started in anesthesia, the only way to avoid intubation during surgery was to manually assist ventilation with a bag-valve-mask attachment. Cases that went on for hours often resulted in cramped fingers, and sometimes progressively poorer ventilation over time as the hand holding the mask became overly tired. A poor mask seal could potentially cause the stomach to distend with air, pushing up the diaphragms, limiting tidal volume, and increasing the risk of aspiration. The LMA has changed anesthesia so much that residents now find it challenging to find cases to practice their masking skills.
However, the LMA is so commonly used, and so apparently safe, that it’s easy to become complacent. Research is showing that it’s apparently very common for us to over-inflate our LMA cuffs — to the potential harm of our patients. Continue reading →
I really like the LMA Supreme, which is a next generation LMA, or laryngeal mask airway. Ease of insertion, presence of a gastric port, and the option for using higher ventilatory pressures make the LMA Supreme more versatile and applicable for use in higher risk patients. However, if you’re a fan of using alternative placement techniques for inserting the the Unique LMA, or its reusable version the Classic LMA, it can be a little challenging to use. Also, if you aren’t careful you can give your patient a nasty cut on the lip during insertion. How does the Supreme differ from the Unique? Continue reading →
This article discusses Laryngeal Mask Airway (LMA) insertion technique – especially ways to ensure that the tip of the cuff doesn’t fold over or trap the epiglottis. The LMA provides an alternate means to ventilate a patient during surgery — without intubation and while freeing the provider’s hands from having to hold the mask. It provides a more secure airway that makes gastric distention less likely. Since its invention, the LMA has since become quite valuable as a rescue device in situations when intubation may be difficult — even for the inexperienced. Let’s talk about some tips for LMA insertion. Continue reading →