Laryngeal Mask Airway

Question 1

LMA - Indications

Answer 1

• LMA provides improved airway latency and ventilation compared with face mask and OPA
• For use in unconscious patient without gag reflex where >10/60 assisted ventilation required

Question 2

LMA - Contraindications

Answer 2

GREATSx1a

• gag reflex present
• resistance to insertion
• epiglottitis suspected
• (upper) airway obstruction
• trismus / strong jaw tone
• sedation to assist / maintain placement of LMA - if the conscious state of the patient improves and there is an attempt to reject the LMA, it must be removed
• only one attempt may be made to re-insert LMA

Question 3

LMA - Precautions

Answer 3

Sniffing Fat Kids Vomit Gently:
# inability to prepare patient in the sniffing position 
# Fat: obesity, pregnancy, or those requiring increased airway pressures (eg severe asthma) due to increased chance of gastric distension and passive regurgitation
# Kids: patients 14 years or under due to enlarged tonsils
# Vomit: significant volume of vomit in the airway
# Gently: may be used for the unconscious APO patient, however gentle assisted ventilation should be provided

Question 4

LMA - Sizing

Answer 4

Size 3: 30-60kg (max size gastric tube 12)
Size 4: 50-90kg (max size gastric tube 12)
Size 5: 90kg and over (max size gastric tube 14)