critical care medicine
How To Insert a Laryngeal Mask Airway
Contraindications to Laryngeal Mask Airway Insertion
Absolute contraindications There is no medical contraindication to providing ventilatory support to a patient; however, a legal contraindication (do-not-resuscitate order or specific advance directive) may be in force Maximum mouth opening between incisors < 2 cm (nasotracheal intubation or a surgical airway would be indicated in this case) Impassable upper airway obstruction (surgical airway would be indicated in this case) Relative contraindications Consciousness or presence of a gag reflex (patients should be unconscious or receive Drugs to Aid Intubation , such as a sedative and a paralytic agent, prior to LMA insertion) Increased risk of regurgitation in patients with prolonged prior BVM ventilation, obesity, pregnancy > 10 weeks, upper gastrointestinal issues (eg, previous surgery, bleeding, hiatal hernia, gastroesophageal reflux disease, peptic ulcer disease), and in patients who have not fasted. In emergencies, use of an LMA can proceed even with these relative contraindications. Need for high pressure ventilation (the tighter seal of an endotracheal tube or a special LMA designed to form a tighter seal is needed for patients with excessive airflow resistance in the infraglottic airways or lungs) 