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Laryngeal mask airways (LMA) are supraglottic airway devices. They may be used as a temporary method to maintain an open airway during the administration of anesthesia or as an immediate life-saving measure in a patient with a difficult or failed airway. Laryngeal mask airways were introduced into clinical practice in the 1980s, where they were initially used predominantly in the operating room. Since then, their use has become more widespread in the intensive care unit, emergency department, and field settings. This activity describes the indications, contraindications, and techniques involved in placing a laryngeal mask airway and highlights the role of the interprofessional team in the management of patients with difficult airways. Objectives: Outline the technique for laryngeal mask airway use. Describe the indications for laryngeal mask airways. Review the complications of laryngeal mask airways. Explain the importance of well-coordinated teamwork and clear communication to facilitate the appropriate use of laryngeal mask airways in patients with difficult airways. Access free multiple choice questions on this topic.

Laryngeal mask airways (LMA) are single-use or reusable supraglottic airway devices that may be used as a temporary method to maintain an open airway during the administration of anesthesia or as an immediate life-saving measure in a difficult or failed airway as outlined in the difficult airway algorithm published by many societies of anesthesiology worldwide.  Introduced into clinical practice in the 1980s, they were initially used predominantly in the operating room but have become widely used in the intensive care unit, emergency department, and field settings.  LMAs are easier to use and more effective than a bag-valve-mask in the hands of basic life support providers and may be used as an alternative to intubation by advanced life support providers. Some models may be used as a conduit to facilitate endotracheal intubation.[1][2][3]

The distal tip of the collar on the LMA may occasionally roll upwards on insertion, which may hinder optimal placement. Some experts recommend partial inflation of the cuff before insertion or inserting the LMA upside-down and rotating it into position to prevent this complication, but there is insufficient evidence to recommend this practice. Forceful insertion may cause abrasion of the pharyngeal tissues or bleeding. Insufflation of the stomach may occur. It is not known to what degree an LMA will prevent aspiration of gastric contents, and it should be considered a temporary or rescue measure in patients at risk for vomiting and aspiration and not considered a replacement for endotracheal intubation. It may be difficult to maintain an effective seal in patients with high airways pressures. The device may become easily malpositioned during CPR or if the patient is moved during transport and must be maintained in the midline.[8] LMAs are not a good primary airway device in morbidly obese patients as those patients do require higher positive airway pressures that may produce leaks around the LMA cuff. In addition, having morbidly obese patients breathe spontaneously through an LMA during anesthesia may lead to significant hypoventilation due to the position of the patient and the weight of the abdomen.[9] The complication rates with LMAs are low and less than those associated with both endotracheal intubation and the use of bag valve masks.

LMAs have an important role in the management of a patient with respiratory distress. While most healthcare workers are familiar with the endotracheal tube, the use of the LMA does require experience. Healthcare workers, including nurse practitioners who have never used an LMA, should first consult with an anesthesiologist before attempting intubation. The LMA is only a temporary solution to the airway and can be easily dislodged with patient movements; hence, it is generally only used in the operating theater.