An Airway Management Device: The Laryngeal Mask Airway—A Review

Abstract

The laryngeal mask airway (LMA) is an airway management device that has become an accepted part of anesthetic practice in both pediatric and adults surgical patients. It is inserted without the use of a laryngoscope or muscle relaxants into the hypopharynx forming a low pressure seal around the glottis. The LMA provides a better airway than a face mask with or without an oral airway. Insertion techniques are quickly learned and are described in this review. Since the LMA forms a less secure seal than an endotracheal tube (ETT), several important limitations and contraindications exist. This includes patients at high risk for regurgitation of gastric contents into the lungs causing pulmonary aspiration and patients requiring high ventilatory pressures or prolonged ventilation. These contraindications have limited its introduction and utilization in the intensive care unit (ICU). The LMA is a helpful tool in the management of both the expected and unexpected difficult airway, where it may serve both as an emergency airway and as a conduit to intubation of the trachea with an ETT over a fiberoptic bronchoscope (FOB) or gum elastic bougie. A lifesaving airway has been provided by the LMA where no other means of achieving ventilation were possible in patients, including neonates, trauma victims, woman undergoing cesarean section, and in the setting of cardiac arrest. There are very few reported uses of the LMA in the ICU. We believe that familiarity with the LMA's design, use, and limitations by critical care practitioners will increase its use in emergency airway management and in the ICU. The LMA may prove to be the first of a new generation of airway devices placed into the hypopharynx to provide an alternative to the endotracheal tube and mask airway.