Coni Senopadang Hendy

It is being increasingly used in place of a face mask or

tracheal tubes during administration of an anesthetic, to facilitate ventilation. Also used in patients with difficult intubation.

 THE CUFF

THE APERTURE BARS

THE AIRWAY TUBE THE CONNECTOR

THE INFLATION LINE

THE PILOT BALOON THE VALVE

 An LMA consists of a

wide bore tube whose proximal end connects to a breathing circuit and the distal end is attached to an elliptical cuff that can be inflated through a pilot tube.

Generally four types of LMA used these days: Classic LMA Flexible LMA The proseal LMA which has an orifice through which naso -gastric tube can be inserted Fastrach LMA that facilitates intubating patients with difficult airways.

 Increase flexibility

 can separate between the

respiratory and gastrointestinal tract

 Metal handle that serves

to help insertion and intubation

 Verify that the size of the LMA is

correct for the patient

Recommended Size guidelines: Size 1: under 5 kg Size 1.5: 5 to 10 kg Size 2: 10 to 20 kg Size 2.5: 20 to 30 kg Size 3: 30 kg to small adult Size 4: adult Size 5: Large adult/poor seal with size 4

 No 1 : 2-4 ml No 2: Up to 10 ml No 2.5: Up to 15 ml No 3 : Up to 20 ml No 4: Up to 30 ml No 5 : Up to 30 ml

 Choose the appropriate size (Table 53) and check for

leaks before insertion. The leading edge of the deflated cuff should be wrinkle-free and facing away from the aperture (Figure 59A). Lubricate only the back side of the cuff. Ensure adequate anesthesia (regional nerve block or general) before attempting insertion. Propofol with opioids provide superior conditions compared with thiopental.

 Place patient's head in sniffing position (Figure 59B

and Figure 516). Use your index finger to guide the cuff along the hard palate and down into the hypopharynx until an increased resistance is felt (Figure 59C). The longitudinal black line should always be pointing directly cephalad (ie, facing the patient's upper lip). Inflate with the correct amount of air (Table 53). Ensure adequate anesthetic depth during patient positioning.

 Obstruction after insertion is usually due to a down-

folded epiglottis or transient laryngospasm. Avoid pharyngeal suction, cuff deflation, or laryngeal mask removal until the patient is awake (eg, opening mouth on command).

INTERNAL VIEW OF PLACEMENT OF LMA

 Failure to press the

deflated mask up against the hard palate or inadequate lubrication or deflation can cause the mask tip to fold back on itself.

 Once the mask tip has

started to fold over, this may progress, pushing the epiglottis into its down-folded position causing mechanical obstruction

 If the mask tip is deflated

forward it can push down the epiglottis causing obstruction deflated it may either
penetrate the glottis.

If the mask is inadequately

push down the epiglottis

 Situations involving a difficult mask (BVM) fit. May be used as a back-up device where

endotracheal intubation is not successful. where a surgical airway is the only remaining option.

May be used as a second-last-ditch airway

Pregnant (Greater than 14 to 16 weeks pregnant) Patients with multiple or massive injury Massive thoracic injury Massive maxillofacial trauma Full stomach patient at risk of aspiration Pharyngeal pathology (e.g abscess). Pharyngeal obstruction .

Although LMA is clearly not a substitue for tracheal intubation but it has proven particularly helpful as a temporizing measure in patients with difficult airways because of its easy of insertion and relatively high success rate (95-99%).