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Techniques and devices for airway management for anesthesia: Supraglottic devices (including laryngeal mask airways)

Author
D John Doyle, MD, PhD
Section Editor
Carin A Hagberg, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Supraglottic airways (SGAs) are a group of airway devices that can be inserted into the pharynx to allow ventilation, oxygenation, and administration of anesthetic gases, without the need for endotracheal intubation. For anesthesia, these devices are used for primary airway management, for rescue ventilation when facemask ventilation is difficult, and as a conduit for endotracheal intubation.

The SGAs used most commonly in the operating room are the laryngeal mask airways (LMAs) and similar devices, while other SGAs are used more commonly in the emergency department and for prehospital airway management (eg, Combitube, laryngeal tube, pharyngeal tube). The LMA consists of a hollow shaft or tube connected to a mask-like cuff designed to sit in the hypopharynx facing the glottis, with the tip at the esophageal inlet (figure 1 and picture 1).

This topic will discuss the LMA and similar devices as they are used in anesthesia, including placement and ventilation techniques, endotracheal intubation through the LMA, and use in special clinical situations. Unless stated otherwise, in this topic, LMA will be used in a generic sense, referring to a category of airway devices, rather than to a specific manufacturer. Use of SGAs in emergency medicine and the use of other airway devices in anesthesia are discussed separately. (See "Devices for difficult emergency airway management in adults" and "Airway management for induction of general anesthesia" and "Flexible scope intubation for anesthesia" and "Direct laryngoscopy and endotracheal intubation in adults".)

ROUTINE LARYNGEAL MASK AIRWAY

The laryngeal mask airway (LMA) is used clinically as an alternative to both mask ventilation and endotracheal intubation. It is usually easily placed and is less stimulating than endotracheal intubation, but it does not provide complete protection against aspiration and does not prevent laryngospasm. Choice of airway device for anesthesia is discussed separately. (See "Airway management for induction of general anesthesia", section on 'Choice of airway device'.)

Choice of laryngeal mask airway — There are multiple types of reuseable and disposable LMAs and other supraglottic airways (SGAs) (picture 2 and picture 3). Although the LMA brand is the oldest and best known brand, a number of other companies manufacture SGAs. The original LMA and similar devices are referred to as first-generation SGAs. These basic, first-generation SGAs include an airway tube with a mask-like cuff. Some alternative-brand SGA products duplicate the functionality of the original LMA at low cost (eg, products from Portex [Portex Soft Seal] and Ambu [AuraStraight]), while others are materially different from the original LMA (eg, i-gel, air-Q, Ambu Aura-i, LMA Supreme).

                      

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Literature review current through: Nov 2016. | This topic last updated: Mon Jul 11 00:00:00 GMT 2016.
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