Status
Unable to intubate / difficult intubation and:
- Unconscious Pt without gag reflex
- Ineffective ventilation with BVM / Oxysaver and airway Mx (OP/NP)
- >10 minutes assisted ventilation required
Contraindications
- NON-MICA Paramedic - Intact gag reflex or resistance to insertion - Strong jaw tone + trismus - Suspected epiglottitis or upper airway obstruction
Consider
Precautions - Inability to prepare the older child in the “sniffing position” - Pts who require high airway pressures, e.g. increased airway resistance (severe asthma) - Pts <14 years of age due to enlarged tonsils - Significant volume of vomit in airway
Side Effects - Correct placement of the LMA does not prevent passive regurgitation or gastric distension

LMA Sizes and Cuff Inflation
LMA Size	Patient Weight	Inflation
1	<5kg	NA
1.5	5-10kg	NA
2	10-20kg	NA
2.5	20-30kg	NA
3	30-40kg	NA

Special Note

The LMA provides improved airway and ventilation Mx compared with a facemask and OPA. The LMA does not protect against aspiration, although studies have shown it to be as low as 3.5% with an LMA compared to 12.4% with a Bag Valve Mask (BVM). The LMA should therefore not be regarded as the equivalent of endotracheal intubation.

The LMA forms a low pressure seal around the posterior perimeter of the larynx and when correctly inserted is seated superior to the oesophageal sphincter thus enabling positive pressure ventilation via BVM or closed circuit resuscitator. Unconscious Pts who accept an OPA are generally suitable for insertion of an LMA.

General Care

If insertion fails and ventilation is difficult or inadequate, check position of LMA cuff using a laryngoscope. If minor adjustment fails to correct the problem, remove the LMA inflated. Immediately insert an OPA/NPA and ventilate the Pt using a BVM.

Only one attempt may be made to reinsert LMA. If insertion fails on the 2nd attempt, do not delay returning to BVM using an OPA/NPA

Do not over inflate cuff.

The LMA may be inserted in left or right lateral positions or if entrapped, in a sitting position. Pts may be managed in the lateral position when the LMA has been correctly inserted and taped in situ, using Transpore or Sleek, however, in general, it is recommended that Pts be Mx supine and carefully observed for aspiration.

If the conscious state of the Pt improves and there is an attempt to reject the LMA, remove the LMA with the cuff inflated.