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LMA: Intubation guide

Indications for use: The LMA device is appropriate for elective cases, as a rescue device, in expected difficult airway situations or in fasting patients. It can be used in CPR situations if the patient is profoundly unresponsive.

Contraindications include morbidly obese individuals, pregnant women > 14 weeks gestation, individuals at increased risk for aspiration, patients in which peak inspiratory pressures may exceed 20 cm H20.

Remove the single use LMA from the packaging and inspect the device. Look down the lumen of the tube to ensure there are no blockages or loose pieces off debris. Flex the tube to approximately 180 degrees to ensure the tubing does not kink. Throw the device away if any of these defects are found.

Use water-soluble lubricant on the back of the airway device. Be careful not to get lube on the anterior portion of the device, as patients may aspirate the lubricant. Do not use lidocaine for lubricant, as it can inhibit the return of protective reflexes upon extubation.

First deflate the cuff completely. Align the head as you would for a normal intubation. Place your nondominant hand against/under the back of the patient’s head. Using your dominant hand, hold the LMA device like a pencil with your pointer finger lodged in the crevice between the tube and the tear dropped inflation tube. Place the tube on the hard palate and ensure the tip is not flipped up. Advance the device applying gentle pressure and follow the curvature of the hard palate into the posterior aspect of the oropharynx. Inflate the cuff to a low pressure. Do not hold the tube during inflation. After the cuff is inflated, connect to the gas line. Be sure to insert a bite block to remain in place until the LMA device is removed.

The device should not be removed until consciousness returns. The oropharynx should be suctioned. Deflate the cuff entirely prior to removing. You can deflate the cuff partially to assist in pulling secretions out of the oropharynx as the LMA is returned.