Laryngeal Mask Airway (LMA) insertion technique EXTENDED VERSION | Extra tips and 2nd gen LMAs

[@allyfilostyle]

Thank you so much! As a anesthetic nurse this and all your tutorials makes working life easier. Thank you for breaking things down and explaining it clear and easy.

[@tammybambini1096]

Thanks, nice presentation! A few tips: - open the patient´s mouth by first pulling the mandibula forward (like in Esmarch´s) and then open the mouth - you get much better mouth opening that way. - Usually the SGA doesn´t get held up by the tongue on insertion, but the first "obstruction" is because its tip is pushing against the posterior pharynx. Use a finger (remember to double glove, so you can discard one glove after you were in the patients mouth with it) inserted with the SGA to push its tip downward to the hypopharynx - that way you also prevent flipping over the tip of the SGA (which leads to air leakage) and also prevents scraping damage to the posterior pharynx. The second "obstruction" is the tongue that gets caught in the hollow bottom of the SGA - either push until the tongue repositions itself or use a finger. - always check cuff pressure and with iGEL don´t use an oversized SGA - we had a case of necrotic tongue because of that. - you can insert a gastric tube in a second generation SGA to stabilize the SGA (especially in patients with no teeth) and thereby you might be able to achieve a sufficient seal. - iGEL initially always leak - they need time for the special plastic to warm up and conform itself to the hypopharynx. - besides head- and SGA-reposition maneuvers you can also deepen the sedation (before applying relaxants)

[@chengtan8236]

Nice video and nice tips!!

[@armuk]

good tips. lingual nerve injury is another known complication with Igels, one more reason to use smaller size as & when possible

[@shinedlight1111]

Laryngeal Mask Airway insertion. Nice record sir...

[@ABCsofAnaesthesia]

thanks!

[@utterdisorder]

Great presentation. Just knit picking, Igel is not a second generation LMA, but a second generation SGA. LMA is trademarked by Teleflex. We do use LMA instead of SGA,but some examiners /consultants are particular. I always love your techniques and explanations. Very useful. Cheers!

[@austinsrna5545]

Providers need to familiarize themselves with their specific brands and models of equipment. Some of these devices are a pain to insert and you'll see all sorts of approaches to how to fix them - tongue blades to get the teeth/lip/tongue away from the laryngeal side of the LMA, people will stick their finger along the back of the throat to ensure the tip doesn't flip and also to stop it from ramming into the posterior wall of the oropharynx and causing trauma, deflating and reinflating the cuff, adding in more air, taking air away, etc etc etc. what most people don't realize is that the packaging often tells you how the company recommends you insert the device, and other specific specifications you should know. What counts as safe trouble shooting for one brand might be unsafe or just useless in another. People are often very unfamiliar with how much air different brands of LMA can safely use; the LMA classic is high-volume/low-pressure, but some of the newer brands are low-volume/high-pressure, and you cant just go shoving 10cc of air into them when they don't seal (I personally witnessed this amongst experienced providers at an academic institution until one day one of their providers bothered to read the company pamphlet).

[@drharry3447]

Easier to insert if you deflate the cuff before insertion & lubricant the surface in contact with the palate

[@tammybambini1096]

Read the manufacturers recommendations - there are many ways (fully deflated, a bit deflated, as provided in package, etc...) and they differ by manufacturer. When lubricating use either water or artificial saliva - do not use gels or sprays that contain local anesthetics

[@the_demio]

Thank you for this session. Detailed and well-explained

[@2233Billy]

Excellent video as always. I'm a 4th year medical student applying to anesthesia. I'm often told I need to push harder to make it past the tongue when placing an LMA. My question is: is it realistically possible to push too hard and cause trauma when trying to surpass the tongue?

[@ABCsofAnaesthesia]

Thanks for the comment and great question! Quick answer, yes! If the lma is too large for the oropharynx it can definitely course trauma resulting in blood in the airway. That said, most juniors are (rightly) careful and dont use enough force.. and after a some experience you get an idea of the maximum force required.. So do as youre doing, play it safe.. be cautious.. and under guidance discover the right amount of force required :)

[@austinsrna5545]

You can definitely catch the tip of the tongue and risk tearing the lingual frenulum if you "push harder" to get it in. Something that is also happening may be the tip in certain brands is a little more stiff and is jamming into the back of the mouth where you can traumatize that soft tissue as well by shoving it. A lot of providers will insert a tongue blade to depress the tongue, this also prevents the LMA from catching onto the teeth and lip. It provides.a ramp of sorts to guide the LMA over. I've heard of people insertion the LMA sideways or upside down and flipping it once past the tongue, but then you run into issues of the cuff possibly being folded in different directions in the hypopharynx ... Not to mention many patient's mouths are way too small to have the device doing barrel-rolls in them.

[@simonrochus]

Fantastic video as always

[@mordechaikiewe4871]

Thanks great stuff as per usual

[@sowmiyaamal2131]

Very useful sir. Please do make a video on upper limb nerve blocks .

[@tammybambini1096]

You might want to look into laryngeal tube-SGA en.wikipedia.org/wiki/Laryngeal_tube instead of the LMA-style SGA known from OR for emergency airways on normal wards - they are easier to place and seal, and they have a portion that extends into the esophagus with a balloon sealing the esophagus a bit better. Placement procedure is the same.

[@gucci9566]

Dear sir is there any marking up to where we should insert just like endotracheal tube?how much air should we inject to fill it

[@tammybambini1096]

Just read the manufacturers manual - it usually has all the details... As for how much air to inject: use a cuff pressure gauge and inflate it so it sufficiently seals but stay below 60cm H2O. As for laryngeal tube airways: use the provided colour-codes syringe.

[@doctorannshalini]

Amazing content! Very practical❤

[@hanadisabagh8299]

Thanks

[@roxyali9815]

Thank u ,it was helpful

[@mariatubangura-di2pr]

Thanks you for this video

[@jennymccormick2244]

That seems very aggressive and tough smashing against the vocal cords. What do you suggest for people with vocal cord injuries that has had multiple vocal cord surgeries in the past and a history of Laryngeal nerve damage?

[@janakchaudhary4063]

Doesn't pass vocal cords, only mask them above( also known as supraglottic airways)

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U didn't talk about lubricating the LMA before insertion. I want to know why.

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