Laryngeal Mask Airway Overview

Study Notes

Used as an alternative to face masks or tracheal tubes during anesthesia.
Low-cost, disposable and reusable versions widely available.
Components:*
Transparent tube with standard 15mm connection.
Elliptical cuff resembling a small face mask to create a seal around the larynx.
Pilot balloon with a self-sealing valve.
Two slits prevent the epiglottis from obstructing the lumen.
Indications for Use:*
Improve oxygenation in rapid sequence airway approaches.
Patients who cannot be intubated.
Elective anesthesia cases.
Cardiac arrest.
Contraindications:*
Increased risk of aspiration in cases of prolonged mask ventilation, morbid obesity and pregnancy.
Known or suspected abnormalities in supraglottic anatomy
Consciousness or presence of a gag reflex.
Complete upper airway obstruction.
Inability to open the mouth.
Insertion Technique:*
Select appropriately sized LMA.
Inflate and deflate cuff to check volume and ensure no leaks.
Apply sterile, water-soluble lubricant to the cuff's posterior surface.
Pre-oxygenate the patient.
Flex patient's neck and lift their chin (sniffing position).
Insert LMA into the mouth, pushing with the index finger in the notch where the tube connects to the mask.
Inflate the cuff.
Connect a bag-valve apparatus to the tube.
Initiate ventilation (8-10 breaths/minute, 500mL each breath).
Assess lung ventilation through auscultation and chest rise.
Verify placement using end-tidal carbon dioxide monitoring.
Secure the tube appropriately.

Tracheostomy: A surgical procedure creating an opening in the trachea for airway access and ventilation.
Tracheostomy Tracheal Tubes:*
Curved plastic tubes inserted through the second, third and fourth cartilage rings of the trachea.
Components:*
Proximal end with standard 15mm connector.
Introducer for insertion.
Wings (flange) for securing the tube.
Cuffed or uncuffed options available.
Pilot balloon and Inflation line for cuffed tubes.
Square cut tip to reduce obstruction risk.
Indications for Tracheostomy:*
Facilitating ventilator weaning as patients better tolerate tracheostomy tubes than tracheal tubes.
Maintaining an airway and protecting lungs in instances of impaired pharyngeal/laryngeal reflexes, post major head and neck surgery (e.g. laryngectomy).
Long-term management excessive bronchial secretions in patients with reduced consciousness.
Neuromuscular diseases affecting chest muscles and diaphragm.
Long-term mechanical ventilation.
Upper airway obstruction.
Complications of Tracheostomy:*
Tracheoesophageal fistula.
Bleeding (hemorrhage).
Vocal cord dysfunction.
Subglottic stenosis.
Pneumothorax.
Infection.
Scarring.
Contraindications for Tracheostomy:*
Abnormal airway anatomy.
Enlarged thyroid.
Coagulopathy.