For clinicians and the patients they care for, the laryngeal mask airway (LMA) has proven one of the most significant advances in airway management since the endotracheal (ET) tube. The LMA is an example of a supraglottic airway device (SAD). While this acronym may sound miserable, SADs are anything but—valued widely for their versatility, ease of use, and prioritization of patient comfort. LMAs are particularly valuable to caregivers practicing anesthesia, resuscitation, and intensive care. In this blog, we’ll dive into the benefits and use cases of LMAs, and how they can improve not only patient outcomes, but also comfort, safety, and trust in their practitioner.
LMA Basics
Laryngeal mask airways are a minimally invasive airway management solution, different from other more involved methods such as endotracheal tubes, which require intubation. To understand the basic positioning of LMAs in the body, it’s important to have a grasp on the anatomy of the airway, which can be broken down into the nose, mouth, and throat—or larynx. The oropharynx is the space behind the tongue at the back of the mouth, separated from the larynx by the epiglottis. The epiglottis acts as a sort of “trap door,” covering the opening of the trachea to prevent food from entering the lower airway.
Once a patient is under anesthesia, an LMA can be inserted by guiding it through the mouth, past the oropharynx, over the epiglottis and into place just above the larynx. The LMA is typically an oval-shaped silicone mask with an inflatable cuff, which can be inflated to form a seal around the supraglottic tissues and attached to a bag-valve device or a mechanical ventilator for assisted ventilation.
Enhancing Patient Comfort
In the perioperative environment, patient comfort is a top priority. Clinicians want to ensure their patients feel comfortable, stable, and as relaxed as possible to ensure the best outcome. Medical studies have shown that LMAs contribute significantly to improved patient comfort during procedures, as less anesthetics and stimulation are needed, further increasing the stability of the anesthesia and improving patient recovery. The minimally invasive design of LMAs compared to other methods of airway management also proves advantageous, reducing the risk of a sore throat, excessive coughing, or activating of the gag reflux. Patients respond much more favorably to LMAs than their counterparts, often enjoying speedier, more comfortable recoveries than intubated patients.
Ensuring Patient Safety
For clinicians, only one concern comes before patient comfort: safety. First, do no harm. Once the LMA tube has been inserted, a practitioner selects the amount of air, attaches the air dispenser to the valve, and injects air into the tube to inflate it. This process ensures an airtight seal around the cuff, preventing the patient from aspirating. When inserted properly, the risk of injury to the vocal cords is extremely low. After insertion, the LMA provides a secure, open airway for the duration of the procedure.
Applications Across Medical Procedures
Given a relatively easy insertion process, among a myriad of other benefits, LMAs are highly versatile, and can be used to maintain an open airway during anesthesia administration, and as an immediate life-saving measure when a patient’s airway fails.
Other uses include endoscopy and administration of cardio-pulmonary resuscitation (CPR) during cardiac arrest cases. Of these cases, medical practitioners report that the LMA was easily inserted, even for junior anesthesia staff members without previous experience, and provided a clear and unobstructed airway with no signs of regurgitation or aspiration.
LMAs vs. Other Airway Devices
When compared to ET tubes, LMAs have a competitive edge. LMAs are less invasive, decrease airway trauma and neck mobility requirements, and reduce the risk of laryngospasm and bronchospasm. Comparative studies also show less inflammatory responses post-surgery, decreased risk of vocal cord injury, and shorter stress response times when LMAs were chosen over ET tubes. In general, LMAs are preferred as an alternative to intubation, helping to decrease both procedure and recovery time.
For all their benefits, LMAs are not without limitations. Complications can sometimes result including laryngospasms, nausea, vomiting, coughing, and aspiration. It’s important to bear in mind that LMAs should only be used in pre-fasted patients under anesthesia, and never on patients who are awake, as the LMA may stimulate the gag reflex and induce coughing, gagging, or vomiting.
Common Misconceptions
Despite their advantage over other assisted breathing methods, some clinicians remain reluctant to adopt LMAs thanks to a few common misconceptions about their use. The first of these is that LMAs can become easily displaced during surgery, making them unsuitable for long procedures. Case reports suggest the opposite: LMAs can be used for 10-24 hours without any evidence of adverse effects on the patient or signs of displacement. A second misconception is that LMAs are not suitable for controlled ventilation. This is also untrue, as LMAs can provide rescue ventilation to patients under anesthesia that is technically easier than most other methods! Despite their ease of use, as always, it’s important for qualified, experienced healthcare providers to administer LMAs to ensure the best patient care possible.
Future Trends in Airway Management
Like any other branch of the medical economy, airway management technology continues to innovate. Some of the more exciting advancements on the horizon include nasal, virtual, and video endoscopy, airway ultrasounds, hybrid devices, and the use of burgeoning AI and telemedicine technology in airway assessment and management. The Airway App showcases the unique opportunity smartphone technology presents in airway management, capturing emergency front-of-neck airway experiences and sharing them internationally. As the field continues to develop, patient outcomes will no doubt improve as well, from small scale impact to aspiration prevention and reduced throat irritation, to large scale change like revolutionary insights gained through special physician networks like the Airway App. Either way, the future looks bright.
Thanks to their easy insertion, simple construction, and wide variety of applications, LMAs have become a popular method of airway management. Even more crucially, LMAs prioritize patient comfort and safety, reducing negative side effects and helping to ensure an easy recovery. As the airway management landscape continues to evolve, LMAs will no doubt continue to play a pivotal role, helping clinicians mitigate complications and provide secure, open airways for all.
For more information about SourceMark LMAs or our other innovative solutions, contact a member of our team.