W2 - Laryngeal Mask Airway

Question 1

Name some advantages of using a Laryngeal Mask Airway (LMA)

Answer 1

• Less stimulating than ETT
• Does not require neuromuscular blockade for placement
• Less increase in intrathoracic and intraabdominal pressures during emergence than ETT
• Less cardiovascular reactivity
• Less increase in IOP
• Provides post-op airway and transition to recovery room

Question 2

How does the Laryngeal Mask Airway (LMA) function? (Where is the seal formed?)

Answer 2

It establishes an airway with supraglottic seal

Question 3

All Laryngeal Mask Airway’s (LMA’s) have:

Answer 3

• 15 mm connector
• Airway tube
• Cuff
• Inflation system

Question 4

Some Laryngeal Mask Airway (LMA)’s have:

Answer 4

• Inlet grid
• Drainage system
• Integral bite block

Question 5

Four indications of LMA use:

Answer 5

• Administration of general anesthesia
• Establishing an airway emergently for positive pressure ventilation (PPV)
• Facilitate endotracheal intubation using FFOB and Aintree catheter
• Recovery from high-risk surgical procedures

Question 6

Four contraindications of LMA use:

Answer 6

• Risks of aspiration (GERD, hiatal hernia, not NPO, obesity, etc.)
• Respiratory disease with low compliance and/or high resistance
• Patient position or surgery limiting airway access
• Upper airway pathology (infection, hematoma, cyst, etc.)

Question 7

What are the seven steps of LMA management?

Answer 7

1. Preparation
2. Induction of general anesthesia
3. Insertion
4. Inflation
5. Confirmation
6. Securing the LMA
7. Removal

Question 8

Three steps for LMA preparation:

Answer 8

• Use clean technique
• Partially deflate cuff
• Lubricate the cuff

Question 9

The four steps for inducing general anesthesia:

Answer 9

• Place the patient in the surgical position (if possible)
• Preoxygenate
• IV induction with minimum apneic period
• PPV by bag-and-mask without OAW - provides key information

Question 10

What is the most important technique for LMA insertion?

Answer 10

The jaw trust maneuver

Question 11

What are the four methods of confirming proper LMA placement?

Answer 11

• Observe connector rise (chest rise and fall?)
• Listen for a leak at 20 cmH2O
• Observe reservoir bag movement
• Capnography (most important!)

Question 12

What are the four general risks and complications for LMA use?

Answer 12

• Failure to achieve seal
• Failure to provide safe positive-pressure ventilation
• Hypoxemia (oxygen deficiency)
• Hypoventilation (inadequate ventilation)