How is intubation performed following insertion of a laryngeal mask airway (LMA) or intubating laryngeal mask airway (ILMA)?

Updated: Dec 28, 2018
  • Author: Nichole Bosson, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Answer

Intubation through an intubating LMA such as the LMA Fastrach produces higher success rates than intubating through a standard LMA (approximately 95% and 80%, respectively). [7]

The LMA Classic and LMA Unique limit the size of the endotracheal tube (ETT) that can be passed. A 6.0 ETT fits through LMA sizes 3 and 4. LMA sizes 5 and 6 accommodate an ETT up to 7.0.

Inspect the ETT and lubricate it well.

Pass it through the lumen of the LMA tube into the trachea until intubation is complete.

Confirm placement, as shown below.

Intubating through the ILMA. Intubating through the ILMA.
Intubating through the ILMA. Intubating through the ILMA.

A bougie or fiberoptic scope may be used to assist intubation.

The ETT is included with the LMA Fastrach, but a standard ETT can also be used.

Once the patient is intubated, the ILMA can be removed by deflating the cuff and passing it over the tube using a stabilizer rod, as shown.

Removing the ILMA after intubation. Removing the ILMA after intubation.
Removing the ILMA after intubation. Removing the ILMA after intubation.
Intubation complete. Intubation complete.

As an alternative to the standard insertion technique described above, there is evidence that laryngoscope-guided placement of the LMA results in higher initial success rates. [21]


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