Laryngeal Mask Airway

The laryngeal mask airway (LMA) has been widely used in the pediatric population.9 It has been found to be extremely useful in the management of difficult airways. It consists of a large-bore tube terminating in an ovoid, fenestrated cup with an inflatable rim that, when properly placed, forms a seal over the laryngeal orifice ( Fig

14-6). The result is an airway that is superior to a face mask in that it prevents supraglottic obstruction and greatly reduces the likelihood of gastric insufflation, but is less reliable at preventing aspiration than an endotracheal tube. Since it is placed blindly, it avoids the complications of endotracheal intubation that arise from the need to visualize and penetrate the glottic opening. It provides a useful rescue device in the event of a failed endotracheal intubation. Once in place, it can be used as a conduit for fiberoptically guided endotracheal intubation. Its applications and experience with its use continue to expand, and emergency physicians should be familiar with its insertion. LMAs can be sized from neonates to adults. Table 11-3 is a guideline of sizes according to weight.

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