Airway management--LMA, Combitube, Bullard, etc. Flashcards
(33 cards)
What are the primary indications for LMA use?
Difficult mask ventilation, difficult airway, bronchoscopy ventilation, avoid neck manipulation
Why should LMAs not be used in non-fasting patients?
Risk of aspiration due to unprotected airway
What makes LMAs easier to manage than face masks during surgery?
Hands-free once placed and better seal (especially with beards)
Name major limitations of LMA use
More invasive than a mask
Does not protect against aspiration
Requires deeper anesthesia than a mask
Cuff complications: hypoglossal nerve injury, overinflation risks
Skill-dependent (placement, troubleshooting)
Cannot be used when airway pressures are high or gastric emptying is delayed
Why is deep anesthesia required before inserting an LMA?
To prevent gagging, laryngospasm, or discomfort
What are some contraindications to LMA use?
Full stomach / aspiration risk (e.g., not NPO, pregnant >14 weeks, GERD)
Airway obstruction (pharyngeal mass, stridor, anatomy issues)
Poor lung compliance (e.g., ARDS, obesity, PIP >30 cmH₂O)
Morbid obesity or acute abdomen
Thoracic trauma or multiple injuries
Not deeply anesthetized (can trigger laryngospasm or gag)
What are some advantages of LMA over the mask?
Hands-free once placed (no need to hold like a mask)
Better seal than face mask—especially helpful with beards
Less facial trauma compared to mask
Avoids neck manipulation
Easier than intubation for trained providers
Reduces OR pollution from gas leakage
What should be done to the LMA cuff before insertion?
Deflate* the cuff, and lubricate the back side of the cuff
What should you use to anesthetize for LMA insertion?
Small amount of propofol, or local anesthesia, or SLN block (the one where you poke right next to the carotid)
How should the LMA be inserted into the mouth?
Press along the hard palate and into the pharynx using the index finger, then press downward until resistance is met
What is a common cause of obstruction after LMA insertion?
Down-folded epiglottis or transient laryngospasm
Where should the distal tip of the cuff be?
The cuff should rest against and block the upper esophageal spinchter
What are is a serious complication of a malpositioned LMA?
Ventilatory FAILURE which can be from insufficient tidal volume, air leak, and airway obstruction
What size LMA would you use for a 30-50 kg (small adult)? How much volume would you put in the cuff? What is the largest ETT for this person?
3 LMA
20 cc
6.0 cuffed
What size LMA would you use for a 50-70 kg? How much volume would you put in the cuff? What is the largest ETT for this person?
4 LMA
30 cc
6.0 cuffed
What size LMA would you use for a 70-100 kg? How much volume would you put in the cuff? What is the largest ETT for this person?
5 LMA
40 cc
7.0 cuffed
What size LMA would you use for a >100 kg? How much volume would you put in the cuff? What is the largest ETT for this person?
6 LMA
50 cc
7.0 cuffed
You would likely just intubate this person and not use an LMA, because obesity is a contraindication for LMA
What additional feature does the ProSeal LMA have?
Has an extra/separate lumen through which a gastric tube can be inserted and you can suction stomach contents
What advantage does ProSeal LMA offer for ventilation?
ProSeal LMA allows for positive pressure ventilation with higher leak pressures (26-28 cm H2O)
Why is the ProSeal considered safer for aspiration risk than a standard LMA?
It provides gastric drainage and improved seal
What type of LMA is used for tracheal intubation?
Fastrach LMA
What size ETT can be blindly inserted through a classic LMA?
6.0 ETT, if you need a larger ETT then use the Fastrach to insert it
What tool allows visualization of the cords during LMA-assisted intubation?
Fiberoptic scope to visualize the cords
What type of ventilation should you have when using an LMA?
The patient should able to do spontaneous ventilation
However you still may need to assist with ventilation to maintain ETCO2 (assist every 3rd breath was Terri’s tip)
