Page 168 - Clinical Application of Mechanical Ventilation

134 Chapter 5

Soft Palate

Uvula Posterior
Third of
Tongue
Epiglottis
Aryepiglottic
Fold
Laryngeal
Inlet Pyriform
Fossa
Interarytenoid
Notch Mucous
Membrane
Covering
Thyroid Gland
Cricoid Courtesy of LMA North America, Inc.
Cartilage
Esophagus Upper
Esophageal
Sphincter
Figure 5-8 Dorsal view of the LMA showing position in relation to pharyneal anatomy.

necessary therefore for the LMA to enter the larynx or trachea. Figure 5-8 shows
the dorsal view of the position of the LMA in relation to the pharyngeal anatomy.
After proper placement, spontaneous ventilation or low-level positive pressure ven-
tilation (up to 20 cm H O for most LMA types) is possible without an endotracheal
2
tube (LMA North America, Inc., 1999).
The LMA is also indicated as a method of establishing a patent airway during
resuscitation in the profoundly unconscious patient with absent glossopharyn-
geal and laryngeal reflexes who may need assisted ventilation. The LMA should be
LMA should be consid- considered when tracheal intubation is precluded by lack of expertise or equipment
ered when tracheal intubation
is precluded by lack of exper- or when attempts at endotracheal intubation have failed (LMA North America, Inc.,
tise or equipment or when
attempts at endotracheal 1999). According to the adult Basic Life Support (BLS), LMA is recommended as
intubation have failed. an alternative airway to the bag-mask device. In adult Advanced Cardiovascular Life
Support (ACLS), the LMA is classified as an intervention that is acceptable, safe,
and useful. In Neonatal Resuscitation, the LMA is recommended as an alternative
in a situation of “cannot intubate” or “cannot ventilate” (LMA North America, Inc.,
2012).
Other uses and application of the LMA are outlined in Table 5-5.

Contraindications for L MA

The design of the LMA does not protect an airway from the effects of regurgitation
The LMA does not protect and aspiration. For this reason, the LMA should not be used in patients who have
an airway from the effects of
regurgitation and aspiration. not fasted or those with hiatal hernia. The LMA should not be used in patients who
are not profoundly unconscious and in those with severe oropharyngeal trauma.

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