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2024-07-09
Placement Techniques
To prevent the patient from coughing, gagging, laryngospasm, breath holding, or straining, adequate depth of anesthesia is usually achieved with intravenous (IV) or inhaled anesthetics before SGA placement. Successful SGA placement in awake patients has also been reported with adequate oropharyngeal topical anesthesia [9]. In general, SGA placement is less irritating than endotracheal intubation.
Several methods of SGA placement have been reported; we generally follow the manufacturer's instructions for placement of the LMA Classic before trying other methods. The technique is summarized below:
● Lubricate the LMA cuff with a water-based lubricant.
● Then grasp the device with your dominant hand and place your index finger at the junction of the cuff and airway tube.
● Use your index finger to press the cuff upward against the hard palate and then move it smoothly back and down along the hard palate until resistance is met. When the index finger is removed, immediately push down on the LMA with your nondominant hand to prevent dislodgement.
●The cuff is then inflated to a target pressure of approximately 44 mmHg or the minimum pressure required to achieve an adequate seal.
When properly inserted, the LMA rests on the glottis and the epiglottis is positioned within the vent of the laryngeal mask. Correct LMA position can be confirmed clinically by:
●Positive pressure ventilation (PPV) is easier to achieve and requires lower ventilation pressures
●The chest rises appropriately with each breath
●Normal capnography
●No leaks during positive pressure breaths at a peak pressure of 20 mmHg
When the LMA is properly positioned, cuff inflation may cause the tube to move outward and slight bulging of the neck. However, some malpositioning may not be clinically obvious and may not be recognized unless the FIS is used. Common causes of malpositioning include folded epiglottis or LMA cuff folding, which may require reinsertion.
After insertion of the LMA, cuff pressure can be checked with a dedicated pressure gauge unless the LMA has a built-in pressure gauge.
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