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LMA: An Alternative to ET

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Dr Shruthi TK, Chennai    16 January 2018

  1. Laryngeal mask airway (LMA) - It is a device that facilitates oxygenation and ventilation without endotracheal intubation.
  2. LMA has a significant impact on practice of anesthesia, management of the difficult airway, cardiopulmonary resuscitation in children and neonates.
  3. It is easy to insert, needs local anesthetic spray and lighter sedation. Muscle relaxants can be avoided.
  4. LMA has revolutionized diffi cult airway management. It can bypass obstruction at the supraglottic level and allow rescue oxygenation and ventilation.
  5. Few conditions successfully managed with LMA include: head and neck vascular malformations, Pierre Robin syndrome, Treacher Collins syndrome, Goldenhar syndrome, Mucopolysaccharidoses.
  6. LMA is used for a variety of surgical procedures. It has replaced the endotracheal tube (ET) for short procedures.
  7. Common misconceptions about LMA use in children – LMA can easily be displaced, so it is unsuitable for long procedures; it cannot be used for controlled ventilation; it cannot be used in newborns (<5 kg).
  8. LMA has been used as a tool for use both in the non-emergency and the emergency pathway of the ASA Diffi cult Airway Algorithm. When endotracheal intubation is not possible, LMA is an acceptable adjunct for experienced providers.
  9. LMA avoids excessive airway instrumentation, minimizes the risk of trauma, is associated with less risk of airway obstruction by bleeding or edema, circumvents the ‘can’t intubate, can’t ventilate’ scenario.
  10. Advantages of LMA over ET: Ease of insertion – helps in providing a secure airway rapidly; laryngoscopy and muscle relaxants are not needed; hemodynamic and intraocular pressure (IOP) changes are lesser; time consumed for insertion is less; incidence of sore throat is less; it is less stimulating when compared with ET in a reactive airway.

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