Laryngeal Mask Airway

1.  ALERT:  The laryngeal mask airway (LMA) does not constitute definitive airway control. It does not protect the airway from gastric content aspiration and should be used only in a patient with an empty stomach. The LMA is not indicated for patients with decreased pulmonary compliance, because the low-pressure seal that is formed around the larynx may not allow adequate ventilation.5 Avoid using the LMA in patients with obstructive or abnormal lesions of the oropharynx.
2.  Ensure that the patient has an absent glossopharyngeal and laryngeal reflex and is unresponsive.
3.  Perform hand hygiene and apply gloves.
4.  Preoxygenate the patient with a bag-mask ventilation.
5.  If necessary, administer sedation as prescribed.

LMA Classic, LMA Unique

1.  The airway manager inflates the cuff to check for leaks and deflates it to form a spoon shape.
2.  Assist the airway manager in coating the posterior surface of the LMA with a water-soluble lubricant.
3.  The airway manager holds the LMA by positioning his or her index finger in the crease between the airway tube and the laryngeal mask.
4.  Assist as directed as the airway manager inserts the LMA with the cuff tip gliding against the posterior pharyngeal wall.
5.  Observe the airway manager as he or she uses an index finger to push the LMA and apply slight backward (toward the ears) pressure and follow the anatomic curve.
6.  The airway manager advances the mask until resistance is noted at the hypopharynx.
7.  Assist as the airway manager inflates the cuff with air; the volume varies with the size of the LMA. During inflation, the airway manager releases the LMA to ensure that placement is maintained as the cuff expands.
8.  Assess the LMA placement.
9.  Ventilate the patient with a bag-valve and supplemental oxygen.
10. Secure the LMA with tape or a securing device; a bite block may be used.3

Intubating LMA (Fastrach)

1.  Assist the airway manager to deflate the cuff of the mask and apply a water-soluble lubricant to the posterior surface. The airway manager distributes the lubricant over the anterior hard palate.
2.  Observe as the airway manager places the curved metal tube in contact with the chin and the mask tip flat against the palate before advancing the mask.
3.  Observe as the airway manger rotates the mask into place with a circular motion, maintaining pressure against the palate and the posterior pharynx.
4.  Assist the airway manager to inflate the mask. Without holding the tube or handle, the airway manager inflates the cuff to a pressure of 60 cm H2O.

Intubating through the Intubating LMA (Fastrach)

1.  Assist the airway manager to validate ETT cuff integrity.
2.  Observe as the airway manger deflates the ETT cuff, lubricates the ETT, and passes it through the intubating LMA tube.
3.  Observe the airway manager advance the ETT to the 15-cm depth indicator.
4.  Observe as the airway manager uses the handle to gently lift the device 2 to 5 cm.
5.  The airway manager advances the ETT until intubation is complete.
6.  Assist the airway manager to inflate the ETT cuff and confirm intubation.
7.  Assist the airway manager to remove the LMA. The airway manager removes the connector and gently eases the intubating LMA out over the ETT into the oral cavity while using the stabilizer rod to hold the ETT in position as the LMA is pulled over the tube.
8.  Assist the airway manager to remove the stabilizer rod and hold onto the ETT at the level of the incisors. 9.  Observe as the airway manager removes the intubating LMA completely.
10. Replace the ETT connector.
11. Reconfirm tube placement.
Post Procedure

12. Discard used supplies, remove gloves, and perform hand hygiene.
13. Document the procedure in the patient's record

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