LMA (1).ppt

LMA PPT

1. LaryngealMask
Airways (LMA)
PRESENTER :-DR. SHRI EASWARI.S
MODERATOR :-DR.SHIVAKUMAR.K.M
ASSISTANT PROFESSOR
DEPARTMENT OF ANAESTHESIOLOGY

2. SPECIFIC LEARNING OBJECTIVES
•Indications,ContraindicationsandSideEffectsofLMAuse.
•ThestepsnecessarytoprepareforLMAplacement.
•ThemethodsofLMAplacement.
•ProblemsassociatedwithLMAplacement.

3. INTRODUCTION
•LMAisaminimallyinvasivedevicedesignedforthe
managementoftheairwayinunconsciouspatients.
•Ithasbeenusedinmorethan200millionpatients
worldwidewithnoreportedfatalities.
•IntroducedintoAmericansocietyofAnaesthesiologists
{ASA}difficultairwaymanagementalgorithmin
1995.

4. •Featuresofanidealsupraglotticairwaydevice
•Itshouldefficientlysealtheupperairwayduringspontaneous
andpositivepressureventilation
•Shouldhavelowresistancetorespiratorygasflow
•Itshouldprotectsubglotticairwayfromupperairway
secretionsandgastriccontents
•Shouldhavelowincidenceofairwaymorbidityandadverse
effects
•Theshape,material,cuffvolume,cuffpositionshouldbesuch
thatitiseasilyacceptedbytheoropharynx.

5. TheLMAwasinventedbyDr.ArchieBrainatthe
LondonHospital,Whitechapelin1988
TheLMAconsistsoftwoparts:
Themask
Thetube
TheLMAhasproventobeveryeffectiveinthe
managementofairwaycrisis

6. TheLMAdesign:
•Providesan“ovalsealaroundthe
laryngealinlet”oncetheLMAis
insertedandthecuffinflated.
•Onceinserted,itliesatthe
crossroadsofthedigestiveand
respiratorytracts.

7. Indications for the
use of the LMA
•Situations involving a difficult mask (BVM) fit.
•May be used as a back-up device where endotracheal
intubation is not successful.

8. USING THE LMA FAMILY
•SIZESELECTION
•PREUSEINSPECTION
•MASKPREPARATION
•ANESTHETICINDUCTION
•AWAKEPLACEMENT
•CUFFINFLATIONANDASSESSINGPOSITION
ANDFUNCTION
•FIXATION

9. •INTRAOPERATIVEMANAGEMENT
•EMERGENCEFROMANESTHESIA
•CAREANDCLEANING
•LIFESPAN
•DEADSPACE
•FLOWRESISTANCEANDWORKOFBREATHING

10. Size Selection
Verify that the size of the LMA is correct for the
patient
Recommended Size guidelines:
Size 1: under 5 kg
Size 1.5: 5 to 10 kg
Size 2: 10 to 20 kg
Size 2.5: 20 to 30 kg
Size 3: 30 kg to 40kg
Size 4: 40kg to 50kg
Size 5: >50kg

11. PRE USE INSPECTION
•VisuallyinspecttheLMAcufffortearsorotherabnormalities
•Inspectthetubetoensurethatitisfreeofblockage,cutsorloose
particlesandkinkingofthespiralwires
•Deflatethecufftoensurethatitwillmaintainavacuum
•Inflatethecufftoensurethatitdoesnotleak
•Theconnectorshouldfittightlytotheouterendoftheairway
tube

12. Deflation and Inflation of the LMA
•Slowlydeflatethecufftoformasmoothflatwedge
shapewhichwillpasseasilyaroundthebackofthe
tongueandbehindtheepiglottis.
•Duringinflationthemaximumairincuffshould
notexceed:
•Size1: 4ml
•Size1.5: 7ml
•Size2: 10ml
•Size2.5: 14ml
•Size3: 20ml
•Size4: 30ml
•Size5: 40ml

13. Mask Preparation
•UseawatersolublelubricanttolubricatetheLMA
•OnlylubricatetheLMAjustpriortoinsertion
•Lubricatethebackofthemaskthoroughly
•ImportantNotice:
•Avoidexcessiveamountsoflubricant
•ontheanteriorsurfaceofthecuffor
•inthebowlofthemask.
•Inhalationofthelubricantfollowingplacementmayresultin
coughingorobstruction.

14. Positioning
of the Airway
•Extendtheheadandflextheneck
•AvoidLMAfoldover:
•Assistantpullsthelowerjaw
downwards.
•Visualizetheposteriororal
airway.
•EnsurethattheLMAisnot
foldingoverintheoralcavity
asitisinserted.

15. ANAESTHETIC INDUCTION
•Requiressufficientgeneralortopicalanaesthesiato
obtundtheairwayreflexes
•Absenceofmotorresponsetoajawthrustindicates
adequacyofanaesthesiaforLMAinsertion
•GreaterdepthrequiredforLMAprosealthanforLMA
classic

16. AWAKE PLACEMENT
•LMAcanbeinsertedinawakepatientsfollowing
topicalanaesthesiaoftheupperairwaysornerve
blocks
•Maskinsertionshouldbeco-ordinatedwith
swallowing[partialinflationofthecuffmaystimulate
bolusoffood&maybehelpfulininsertion]

17. LMA INSERTION TECHNIQUES
•STANDARDTECHNIQUE
•180DEGREETECHNIQUE
•PARTIALINFLATIONTECHNIQUE
•THUMBINSERTIONTECHNIQUE

19. Standard
Technique

20. LMA Insertion Step 1
•GrasptheLMAbythetube,
holdingitlikeapenasnear
aspossibletothemaskend.
•PlacethetipoftheLMA
againsttheinnersurfaceof
thepatient’supperteeth

21. LMA Insertion Step 2
•Underdirectvision:
•Pressthemasktipupwards
againstthehardpalatetoflatten
itout.
•Usingtheindexfinger,keep
pressingupwardsasyouadvance
themaskintothepharynxto
ensurethetipremainsflattened
andavoidsthetongue.

22. LMA Insertion Step 3
•Keeptheneckflexedandhead
extended:
•Pressthemaskintothe
posteriorpharyngealwall
usingtheindexfinger.

23. LMA Insertion Step 4
•Continuepushingwithyour
indexfinger.
•Guide the mask
downwardintoposition.

24. LMA Insertion Step 5
•Graspthetubefirmlywiththe
otherhand
•thenwithdrawyourindex
fingerfromthepharynx.
•Pressgentlydownwardwith
yourotherhandtoensurethe
maskisfullyinserted.

25. LMA Insertion Step 6
•Inflatethemaskwiththe
recommendedvolumeofair.
•Donotover-inflatetheLMA.
•DonottouchtheLMAtubewhileitis
beinginflatedunlessthepositionis
obviouslyunstable.
•Normallythemaskshouldbeallowedto
riseupslightlyoutofthehypopharynxas
itisinflatedtofinditscorrectposition.

26. 180 DEGREE TECHNIQUE
•LMAinsertedwithlaryngealaperturepointing
cephalad&rotateit180degreesasitenters
hypopharynx
•Satisfactoryasstandardtechniqueespeciallyin
paediatricpatients
•Drawback-bulkycuffincloseproximityto
hypopharynxcoulddislocatearytenoidcartilage

27. PARTIAL INFLATION TECHNIQUE
•Cuffpartiallyorfullyinflatedbeforeinsertion
•Incidenceofsorethroatisreduced

28. THUMB INSERTION TECHNIQUE
•Suitableinpatientswhereaccesstoheadfrombehindis
difficult
•SimilartostandardtechniqueexceptthatLMAisheld
withthumbinthepositioninsteadofindexfinger

29. CUFF INFLATION & ASSESSING THE
POSITION
•Cuffshouldbeinflatedtopressureofapproximately60cmofH
2Oover3-
5secondswithoutholdingthetube
•Thisusuallycausesslightupwardmovementoftheairwaytube&oval
bulgingatthefrontoftheneck&novisiblecuffintheoralcavity
•Cuffsizeismoreimportantthantheinflatingvolumeindeterminingthe
sealorleakpressure
•Inpositivepressureventilation,leakpressureshouldbegreaterthan20cm
H
2O[30cmH
2OforLMAproseal]
•Inspontaneousventilationleakpressureshouldbegreaterthan20cmH
2O

30. Verify Placement of the LMA
•ConnecttheLMAtoBain’scircuit&ventilate
•Observechestmovements
•Normalbreathsoundsonauscultation
•Volumemonitoringnotshowingaleak

31. Verify Placement of the LMA
•Carbondioxidewaveformswithpositivepressure
ventilation
•Reservoirbagexcursionsinspontaneousventilation
•Fiberscopeorrigidendoscopecanbeinsertedthrough
theLMAtoconfirmitsposition&ruleoutobstruction
•Oesophagealdetector,x-rayorMRIcanbeusedto
confirmitsposition

32. Securing the LMA
•Insertabite-blockorrollofgauzetopreventocclusionof
thetubeshouldthepatientbitedown&toimprovethe
stability.[NotnecessaryforLMAproseal]
•OropharyngealairwayifusedwithLMAmaycompressthe
LMAcuffortubeasbotharedesignedtobeplacedin
midline
•Tubeshouldbesecuredwithtapetakingcarethatitdoesn’t
becometwistedorobstructthesurgery

33. Problems with
LMA Insertion
•Failuretopressthedeflated
maskupagainstthehardpalate
orinadequatelubricationor
deflationcancausethemask
tiptofoldbackonitself.

34. Problems with
LMA Insertion
•Oncethemasktiphasstartedtofold
over,thismayprogress,pushingthe
epiglottisintoitsdown-foldedposition
causingmechanicalobstruction

35. Problems with
LMA Insertion
•Ifthemasktipisdeflatedforwarditcan
pushdowntheepiglottiscausing
obstruction
•Ifthemaskisinadequatelydeflateditmay
either
•pushdowntheepiglottis
•penetratetheglottis.

36. INTRAOPERATIVE MANAGEMENT
•Airwaypatency&correctLMAorientationshouldbe
verifiedatregularintervals
•Upperabdomenshouldbeperiodicallyobservedfor
signsofdistension
•Deepen theplaneofanaesthesiaif
laryngospasm/wheezing/swallowing/coughing/breath
holdingoccurs

37. INTRAOPERATIVE MANAGEMENT
•N
2O&CO
2candiffuseintocuffthusincreasingintracuff
pressure&volumecausingairwayobstruction
•CuffPressureshouldbemonitoredperiodicallywitha
pressuregaugeortransducer&keptat60cmH
2O
•LMAcanbeusedforbothspontaneous&controlled
ventilations

38. INTRAOPERATIVE MANAGEMENT
•PressurecontrolledventilationswithorwithoutPEEPisthemode
ofchoiceforcontrolledventilationwithLMAbecauseitallowsa
lowerpeakpressureforthesametidalvolumewithlessleak
aroundtheLMA
•In spontaneously breathing patients, pressure support ventilation
improves gas exchange and reduces the work of breathing

39. •TheworkofbreathingcanalsobereducedbyusingCPAP
•Ifregurgitationoccurs,1
st
signmaybeappearanceoffluid
travellinguptheLMAtube
•Insuchscenariopatientshouldbeplacedinheaddown
position,breathingcircuitdisconnectedandairwaytube
suctioned

40. EMERGENCEFROMANAESTHESIA
•BiteblockmustbeleftinplaceuntilLMAisremoved
•IfcuffremainsinflatedwhentheLMAisbeingremoveda
greatermassofsecretionsisalsoremoved
•LMAshouldnotberemovedinthelighterplaneof
anaesthesia
•LeavingtheLMAinplaceuntiltheairwayreflexeshave
recoveredandthepatientcanphonateoropenmouthon
commandwillensuremaintenanceofasecureairway

41. •Onsetofswallowingisausefulpredictorofimminent
wakefulness
•Inintraocularsurgeriesandinpaediatricagegroupremovalof
LMAisrecommendedindeeperplaneofanaesthesia

42. CARE AND CLEANING
•AssoonaspossibleafterusethereusableLMAshouldbe
gentlycleanedwithwarmwaterandadilute(8-10%)
sodiumbicarbonatesolutionuntilallvisiblematerials
havebeenremoved
•Milddetergentswhichdoesn’tirritatethemucous
membranescanbeused

43. •Pipecleanerbrushcanbeusedtocleanthetube
•Inflationvalveshouldnotbeexposedtoanycleansingsolution
•Watershouldnotbeallowedtoenterthecuff
•Asmuchairaspossibleshouldberemovedfromthecuff
shortlybeforeautoclaving
•LMAcanbeautoclavedattempupto135°c(275°F)
•Highertemperaturemaycausetubetobecomebrittleand
fragment

44. •WHOguidelinesandpublishedliteraturesindicatethat
thesemeasuresaresufficientforinactivationof
conventionalpathogens
•Inpatientswithknownorsuspectedspongiform
encephalopathyitisrecommendedthatLMAbeused
anddestroyedorLMAuniquebeused

45. LIFE SPAN
•Recommended life span for LMA classic is 40 uses

46. DEAD SPACE
•DeadspacewithLMAislessthanthatwithfacemask
butisgreaterthanwithatrachealtube
•correlationbetweenETCO2andarterialCO2isbetter
withlaryngealmaskthanwiththefacemaskandas
accurateaswithtrachealtube
•PreferredsiteformeasuringETCO
2inchildrenisthe
laryngealendoftheshaft

47. FLOW RESISTANCE AND WORK OF
BREATHING
•LMAofferslesserresistancethantrachealtube
•Buttotalrespiratoryresistanceandworkofbreathingare
similar
•LMAflexiblehasasmallerinternaldiametersoitimposes
significantlygreaterresistancethanotherLMA’s

48. USES OF LMA
•Usedinavarietyofproceduresbutbestsuitedforshort
proceduresmakingitespeciallyusefulforoutpatient
procedures
•MaximumdurationforLMAuseisnotknownbuthas
beenusedforsurgerieslastingupto8hrs
•Usefulinpatientswithdifficultfacemasktechnique
•Usefulindifficultorfailedintubation

49. •Ophthalmicsurgeries
•Trachealprocedures
•Diagnosticandtherapeuticfiberopticlaryngotracheoscopy
andbronchoscopy,bronchoalveolarlavageandinplacing
bronchialstent
•Usefulintransoesophagealechocardiography
•Variousheadandneckprocedures
•Thyroidsurgeries-cuffdisplacestheglandanteriorly
facilitatingsurgicalaccess
•Usedforcarotidendarterectomy
•Congenitalconditions

50. •Professionalsingersandspeakers
•Remoteanaesthesia
•Supplementingregionalblocks
•Outofhospitaluseespeciallyintoxicmasscasualtyevents
•Obstetrics
•Lasersurgeries
•Lowerabdominalsurgeries
•Neurosurgeries
•Extracorporealshockwavelithotripsy

51. COMPLICATIONS
•Aspirationofgastriccontents
•Gastricdistension
•ForeignbodyentrappedintheLMAtubemaygetaspirated
orcauseairwayobstruction
•Airwayobstructionduetomalpositioningofthecuff

52. •Trauma
•Posteriorspinalligamentrupture
•Nerveinjury
•Pulmonaryedema
•Transientsalivaryglandsandtongueswellingmayoccur
•Vocalcordedema

53. ADVANTAGES
•Easeofinsertion
•Smoothawakening
•Lowoperatingroompollution
•Avoidingcomplicationsofintubation
•Avoidingcomplicationsoffacemask
•Protectionfrombarotrauma
•Costeffectiveifusedenoughnumberoftimes

54. DISADVANTAGES
•Relativecontraindicationslikefullstomach,previousgastric
surgeries,GERD,diabeticgastroparesis,pregnancy>14wks,
dementia.
•Supraglotticpathologiessuchascysts,abscess,hematoma.
•Presenceofbleedingdisorders
•Lessreliableairwaythanthetrachealtubeasitmaygetdislodged

55. Side-Effects of the LMA
•Throatsoreness
•Drynessofthethroatand/ormucosa
•Sideeffectsduetoimproperplacementvarybasedonthenatureof
theplacement

56. CLASSIFICATIONS:
•BASED ON SEALING MECHANISM
1)CUFFED PERILARYNGEAL SEALERS are of two types
•Without directional sealing: LMA, ILMA, Soft Seal LM,
AmbuLM.
•With directional sealing: PLMA.
2)CUFFED PHARYNGEAL SEALERS are of two types
Without esophagealsealing cuff: Cobra-PLA
•With esophagealsealing cuff: LT ,LTS, Combi tube
3)CUFFLESS PRESHAPED SEALERS: SLIPA,I Gel, Baska
Mask

57. •Supraglottic devices are alternatively classified into
generations:
•FIRST GENERATION
• Only with an airway tube
• Seal pressure of 20cm of water
SECOND GENERATION
• With a gastric channel/port for the drain tube
• A seal pressure of more than 30cm of water
• Bite block.
THIRD GENERATION(debatable) In which the mask seal
improves with each positive pressure breath . E.g; Baskamask

58. LMA CLASSIC
•Consistsofacurvedtube(shaft)connectedtoan
ellipticalspoonshapedmask(cup)at30°angle
•Twoflexiblebarsatthemaskendtopreventthetube
beingobstructedbytheepiglottis
•Inflatablecuffsurroundstheinnerrimofthemask
•Blacklinerunslongitudinallyalongtheposterioraspect
ofthetube

60. •A15mmconnectoratthemachineendofthetube
•LMAismadefromsiliconandcontainsnolatex
•ClassicalLMA’sareavailablein8sizes
•Significanceofthesize-toosmallanLMAwill
predisposetogasleaksduringpositivepressure
ventilation
•ToolargeanLMAmaytendtocomeupwithinthemouth
mayinterferewithproceduresinthemouth,mayincrease
incidenceofsorethroatandmayevendamagethelingual
nerve

61. LMA UNIQUE
•Singleuse,disposablelaryngealmaskairway(dLMA)
•Madeupofpolyvinylchlorideandcostslessthana
reusableLMA
•ThedimensionsareidenticaltostandardLMA,buttube
isstifferandcufflesscompliant
•Indications-betterchoiceforoutofhospitalorwarduse
ComparisonsoftheLMAuniquewithaLMAclassicshow
littledifferenceineaseofinsertionorperformance
IntracuffpressureincreasewithN2ouseissignificantlyless

63. LMA FLEXIBLE
•LMAflexibleorwirereinforcedLMA(R-LMA,F-LMA)
•DiffersfromC-LMAinthatithasaflexiblewirereinforced
tube
•Tubeislongerandnarrowed
•Singleuseversionarealsoavailable
•Theycanbebenttoanyanglewithoutkinking-thisallowsit
tobepositionedawayfromthesurgicalfield
•Lesslikelytobedisplacedduringheadrotation

65. •Indications-designedforuseinsurgeriesofhead&
necksurgeries
•ComparisonsbetweenLMAclassicrevealthatboth
aresimilarintermsofmaskposition,clinical
performance&pharyngealmucosalpressures
•Problems-thewirereinforcementdoesn’tprevent
obstructionfrombiting,toavoidthisBoyle’sDavis
gagmaybeused

66. Spiralreinforcingtubemaybreak&causeairwayobstructionor
mayentertracheobronchialtree
Smallinternaldiameterlimitsthesizeofendoscopeortracheal
tubetobeused
UnsuitableifthepatientisundergoingMRI

67. LMA FASTRACH
•LMAFastrach(IntubatingLMAorI-LMA)wasdesignedto
overcomesomeofthelimitationsoftheLMAclassicduring
trachealintubation
•Anotherobjectivewastoeliminatetheneedtodistortthe
anteriorpharyngealanatomyinordertovisualizethelaryngeal
inlet,makingthedeviceapplicabletopatientswithhistoryof
difficultintubation&ahighoranteriorlarynx

69. •Asingle,movableepiglotticelevatorbarinplaceofthe2
verticalbars
•Av-shapedguidingrampisbuiltintothefloorofthemask
aperturetodirectthetrachealtubetowardtheglottis
•Thetipisslightlycurvedtopermitatraumaticinsertion
•Availableinsizes3,4&5
•Bothreusable&disposableversionsareavailable

70. •Insertedwiththepatientinneutralposition
•Usingheadsupportsuchaspillow,butnoheadextension
•Insertiontechniqueconsistsofonehandmovementsinsaggital
plane
•Itdoesn’trequireplacingfingersintothepatient’smouth,thus
minimizingtheriskofinjuryorinfection,aswellasallowing
insertionfromalmostanyposition

71. DESCRIPTION
•Ithasashort,curvedstainlesssteelshaftwithastandard
15mmconnector
•Tubeisofsufficientdiameterthatacuffed9mmtracheal
tubecanbeinserted&shortenoughtoallowastandard
trachealtubecufftopassbeyondthevocalcords
•Metalhandleissecurelybondedtotheshaftnearthe
connectorendtofacilitateonehandedinsertion,position
adjustment&maintainthedeviceinasteadyposition
duringtrachealtubeinsertion&removal

72. USES
•Designedtofacilitatetrachealintubation
•Canalsobeusedasprimaryairwaydevice
•Usefulforanticipated&unexpecteddifficultairway
•Canbeusedinchildren,morbidlyobese&
acromegalicpatients

73. TRACHEAL INTUBATION
•TrachealtuberecommendedwithLMAFastrachisasilicone,
wirereinforcedcuffedtubewithataperedpatientend&a
blunttip
•Flexibleallowingeasiernegotiationaroundtheanatomical
curvesoftheairway
•ThereisastabiliserwhichallowstheLMAtoberemoved
withoutextubatingthepatient

74. •Itisusefulinblindnasalintubation,fiberscopeguided&light
styletguidedintubation
•Problems-rigidshaftcannoteasilyadapttoachangeinthe
positionofpatient’sneck
•MorelikelytobedislodgedthanLMAclassic
•Cannotbeusedwithcasesinproneposition
•UnsuitableforuseinMRIunit

75. LMA C-TRACH
•SimilarinconstructionwithLMAFastrach
•Ithas2builtinfiberopticchannels
•Fiberopticsystemissealed&robust,sotheLMAC-TRACH
canbeautoclaved
•Monitor(viewer)isattachedtotheLMAC-TRACHbya
magneticlatchconnector,ithascontrolsforfocussing&image
adjustment
•Availableinsizes3,4&5&isreusableupto50times

77. •Itisinsertedwithouttheviewerattached
•Anantifoggingsolutionshouldbeappliedtotheopticallens
•ViewerisattachedaftertheLMAhasbeensecured&the
patientventilated
•Arealtimeimageoflarynxisthendisplayed
•UsefulforsatisfactorypositioningoftheLMA&highfirst
intubationattemptsuccessrate

78. LMA PROSEAL
•Ithas4mainparts-thecuff,inflationlinewithpilot
balloon,airwaytube&drain(gastricaccess)tube
•Allcomponentsaremadefromsilicone&arelatexfree
•Availablein6sizes

80. •AirwaytubeofLMAprosealisshorterandsmallerindiameter
thanthatoflamaclassicandiswirereinforcedwhichmakesit
moreflexible
•Thereisalocatingstrapontheanteriordistaltubetoprevent
thefingerslippingoffthetubeantoprovideaninsertionslotfor
theintroducertool
•Anaccessoryventunderthedrainagetubeinthebowlprevents
secretionsfrompoolingandactsasanaccessoryventilationpor

81. •LMAprosealhasadeeperbowlthantheLMAclassicanddoesnot
haveaperturebars
•Thereisabiteblockbetweenthetubings
•Draintubeisparallelandlateraltotheairwaytubeuntilitentersthe
cuffbowl
•WhentheLMAprosealiscorrectlypositionedthecufftipliesbehind
thecricoidcartilageattheoriginofesophagus(superioroesophageal
sphincter)
•Itallowstheliquidsandgasestoescapefromthestomach
•Gastrictube,Dopplerprobe,thermometerormedicationcanbepassed
intotheesophagusthroughthedrainageport

82. •Aplasticsupportingringaroundthedistaldraintubeprevents
thetubefromcollapsingwhenthecuffisinflated
•LMAprosealhasaseconddorsalcuff,thispushesthemask
anteriorlytoprovideabettersealaroundtheglotticaperture
andhelpstoanchorthedeviceinplace(dorsalcuffisnot
presenton1.5,2and2.5proseal)

83. INSERTION METHODS
•INTRODUCERTECHNIQUE
•DIGITALMETHOD
•GUIDEDMETHOD

84. USES
•Itcanbeusedforbothspontaneousandcontrolledventilation
butismoresuitedforcontrolledventilation
•SealingpressureishigherthanLMAclassicmakingitabetter
choicewherehigherairwaypressuresarerequired
•Usefulforsurgicalproceduresinwhichintraoperativegastric
drainageordecompressionisneeded
•Canbeusedinknowncasesofdifficultairway
•SafeinMRIunit

85. PROBLEMS WITH LMA PROSEAL
•Becauseofitsnarrowairwaytubeitislessusefulin
spontaneouslybreathingpatients
•ItrequiresagreaterdepthofanaesthesiathanwithLMAclassic
•Itcancauseairwayobstructionbycompressingthesupraglotticor
glotticstructuresorbycuffinfolding
•Relativelycontraindicatedforintraoralsurgeriesbecauseitcannot
beeasilymovedaroundthemouth
•IthasshorterlifespanthanLMAclassic

86. LMA SUPREME
•Itisasingleuseversionandhasclinicalutilitiessimilartothatof
LMAproseal
•Ithasareinforcedtipandmouldeddistalcuffwhichprevents
folding

87. LMA AMBU AURA
•Itisdisposablelaryngealmaskwithabuiltincurvethat
replicatesthenaturalhumananatomy
•Ithasasoftcuff,reinforcedtiptopreventfoldingandno
epiglottisbar
•Itcomesin7sizes
•Itisoftwotypes-ambuauraonce,ambuaura40

89. LMA SOFT SEAL
•Itisacleardisposablemaskmadefrompolyvinylchloride
•Theovalcuffdoesn’ttaperatthetip
•Theinflationtubeisattachedtotheairwaytube
•Ithasnoepiglotticbars
•Itisavailablein7sizes
•InsertionprocedureissimilartothatofanLMA
•ThecuffislesspermeabletoN2Othansiliconmasks.Sothecuff
increasepressureislesser
•IthaslowerorequalincidenceofsorethroatcomparedtoC-LMA

91. OTHER SUPRAGLOTTIC AIRWAY
DEVICES
•AMBULARYNGEALMASK
•INTUBATINGLARYNGEALAIRWAY
•LARYNGEALTUBEAIRWAY
•PERILARYNGEALAIRWAY
•STREAMLINEDPHARYNXAIRWAYLINER
•OESOPHAGEALTRACHEALCOMBITUBE

92. AMBU LARYNGEAL MASK
•Itisadisposabledevicethathasacuffthatistaperedatthetube
•Airwaytubeislargerandmorerigid
•Itisavailablein7differentsizes

93. INTUBATING LARYNGEAL AIRWAY
•Itisareusabledevicemadefromsiliconwithaclearcurved
tubeandadarkblueovalbowl
•Bowlhasadownwardtilttopreventslippingbelowthe
epiglottis
•Thesearedesignedtoimprovethesealandhelpisolatethe
oesophagus
•Itisavailablein3sizes

94. LARYNGEAL TUBE AIRWAY
•Itisareusablesilicondevicethathasasinglelumenthatisclosedatthe
tip
•Singleuseversions(LT-D)aremadeofpolyvinylchloride
•Laryngealtubesuction(LTS,Sondalaryngealtube,SLT)hasan
additionaloesphageallumenposteriortotherespiratorylumenthatends
distaltotheoesophagealcuffforsuctioningandgastrictubeplacement
•Laryngealtubehasasmall(oesophageal,distal)cuffneartheblindtip
andalarger(oropharyngeal,proximal)cuffnearthemiddleofthetube
withoneinflationtubetoinflateboththecuffs
•Theairwaytubeisrelativelywide&curved

95. •Theseallowsuctioningoffibrescopepassage
•Thetubesizeinternaldiametercolourcodedontheconnector,
witheachsizehavingadifferentcolour
•Cuffsshouldbeinflatedtopressureof60cmsH2O.The
proximalcuffwillfillfirst&thenfollowedbydistalcuff
•Itcanbeusedinbothspontaneous&controlledventilations
•Itcanbeusedfornasotracheal&oralintubations
•Gasexchangeisthroughtwoanteriorlyfacingovalshaped
openings(ventilationholes)betweenthetwocuffs

97. PERILARYNGEAL AIRWAY
•ItsalsoknownascobraPLA/CPLA
•It’sasingleuseplasticdevice
•Ithashighvolume,lowpressure,ovalcuffthatisshapedtofitinthe
hypopharynxatthebaseoftongue
•Itisavailablein8sizes
•Airwaysealingpressureisfoundtobehigher&thelaryngoscopicview
superiorwiththecobraPLAcomparedwithclassicLMA
•Usefulinpatientswith“difficulttointubate/ventilate”situationswithLMA
classic/Fastrachfailure
•Itsdisadvantageisthatitdoesn’tpreventaspiration

99. STREAMLINED PHARYNX AIRWAY
LINER
•Thestreamlinedlinerofthepharynxairway–SLIPAitisa
plasticdisposableuncuffeddevicethatisanatomically
preshapedtolinethepharynx
•Itisasupralaryngealairwaydevicewithahollowstructure
thatpermitsthestorageofregurgitatedliquidsthereby
minimizingaspirationrisk.
•Itisshapedlikeahollowbootwithatoe,bridgeandheel
•Thereisananterioropeningforventilation
•Endofthetoerestsintheoesophagealaperture

100. STREAMLINED PHARYNX AIRWAY
LINER
•Bridgefitsintothepyriformfossa
•Heelconnectstotheairwaytubewhichisrectangularin
shapeandhasacolourcodedconnector
•Ithasacapacityof15timesthecapacityofLMAclassic,
about45-50ml–50ml.
•Itisavailablein6adultsizes
•AsthereisnocuffN
2Ohasnoeffectonsealingpressure

102. OESOPHAGEAL TRACHEAL
COMBITUBE
•Thecombitubeisasingleusedoublelumenthathasaunique
designthatprovidesanairwayforeitheresophagealortracheal
placement.
•Ithasalargeproximallatexoropharyngealballoonandadistal
oesophageallowpressurecuffwithmultipleholesinbetween.
•Itisusefulinpatientsinwhomneckmovementis
contraindicatedandinthosewhosevocalcordscannotbe
visualizedbecauseofalimitedairwayormassivebleeding.

104. BASKA MASK

105. i-GEL
•Madefromaunique,soft,gel-likematerialtoalloweaseofinsertion
andreducedtrauma.
•Gastricchanneldesignedtoimproveandenhancepatientsafety.
•Integralbite-blockreducesthepossibilityofairwaychannelocclusion.
•Virtuallyeliminatesrotation.
•Reducesthepossibilityofepiglottisdownfoldingandobstructingthe
airway.
•Uniquepackagingprotectsthei-gelintransitandensuresthatit
maintainsitsanatomicalshape.

107. REFERENCES:-
•Understandinganesthesiaequipment–Jerryadorsch&
Susanedorsch
•Miller’s7
th
edition

108. THANK YOU