classification differences from prototype LMA

1. SUPRAGLOTTIC AIRWAY
DEVICES
TESS JOSE
INTERN
DEPARTMENT OF ANAESTHESIA

2. SUPRAGLOTTIC AIRWAY DEVICES INFRAGLOTTIC AIRWAY DEVICES
Above the level of the vocal cords
Eg: Larygeal mask airway
Below vocal cord (DEFINITE AIRWAY DEVICES )
Eg: Endotracheal tube
Tracheostomy

3. Features Of An Ideal Supraglottic Airway Device
• A SAD must efficiently seal the upper airway during spontaneous and
positive pressure ventilation
• It should have low resistance to respiratory gas flow
• It should protect the subglottic airway from upper airway secretions
and gastric contents
• It should have a low incidence of airway morbidity and
adverse events
• The shape, material, cuff volume and cuff position should be
such that it is easily accepted by the oropharynx.

4. INDICATION
• Elective ventilation: as an alternative to ETT for short and elective
surgical procedures under GA
• Difficult airway:
• – As a rescue device during failed intubation or ventilation
• – In a patient who cannot be intubated, but can be ventilated as an
alternative to bag-mask ventilation as it is easier to maintain.
• – In a patient who cannot be intubated or ventilated (CICV), LMA
insertion can be attempted, while preparing for cricothyrotomy

5. • Cardiac arrest: acceptable alternative to intubation during cardiac
arrest
• Conduit for intubation: The SADs can be used as a conduit for
intubation when intubation is unsuccessful. The ETT can be passed
through the SAD or using a special intubating LMA either directly, or
may also be assisted by a bougie or fiberoptic scope
• As a bridge to extubation

6. Classification
based on sealing mechanism
1.Perilaryngeal sealers:
• LMA, ILMA,PROSEAL LMA
2.Pharyngeal sealers:
• Combitube,laryngeal tube
3.Preshaped sealers
• Igel,SLIPA

7. Based on evolution
First generation
Simple airway devices
Classic LMA
Flexible LMA
COBRA LMA
Second generation
Additional dranage tube
Proseal LMA
LMA Supreme
I-Gel
SLIPA
Third generation
Self energizing sealing
mechanism
 BASKA Mask

8. LMA CLASSIC Brain’s LMA
• Comprised of three main components
– Airway Tube
–elliptical silicone mask with inflatable outer
rim
– Inflation line
• Mask designed to conform to the contours
of the hypopharynx with its lumen facing
the laryngeal opening.
• Less invasive
it cannot prevent aspiration
Not a definitive airway device

9. SIZE OF LMA 8sizes

10. PREPARATION PRIOR TO INSERTION
• Select the proper size of LMA.
• Inspect the LMA for any tear , blockage .
• Slowly deflate the cuff to form a smooth flat wedge shape .
• Over inflate: look for leak.
• Use a water soluble lubricant to lubricate the posterior surface of
LMA just prior to insertion.
• Avoid excessive amounts of lubricant -on the anterior surface of the
cuff or -in the bowl of the mask.
• Avoid lignocaine jelly for lubrication .

12. SIGNS OF CORRECT PLACEMENT
• The slight outward movement of the tube upon LMA inflation.
• The presence of a smooth oval swelling in the neck around the
thyroid and cricoid area, or no cuff visible in oral cavity.
• Ventilate the patient while confirming equal breath sounds over both
lungs in all fields and the absence of ventilatory sounds over the
epigastrium.

13. COMPLICATIONS
• postoperative sore throat (m/c)
• arytenoid dislocation,
• trauma to the pharyngeal cavity
• airway edema, tongue edema
• compression of nerves and/or blood vessels due to malposition of
LMA or excessive intracuff pressure
• Laryngeal spasm

14. Laryngeal Mask Airway Classic Excel
• epiglottic elevating bar
• removable connector to facilitate introduction of an ETT through theLMA after placement.
• It has an increased angle which aids intubation.
• reusable up to 60 times

15. LMA UNIQUE
• Single use version of classic LMA.

16. LMA FLEXIBLE
• it has a flexible wire reinforced airway
tube which makes it suitable for head and
neck surgeries.
• Tube is longer and narrower
• Advantage :No need of positioning

17. INTUBATING LMA
• it was designed to act as a conduit for
endotracheal intubation
• Useful in cannot intubate , cannot
ventilate patients
 Consist of rigid anatomically curved steel
airway tube
 Elliptical silicone cuff with epiglottis
elevating bar
 handle

18. Laryngeal Mask Airway ProSeal
• The mask has two tubes attached to it, a drain tube
and a reinforced airway tube and a built in bite block
• drain tube incorporated within the cuff which
communicates with the upper esophageal sphincter
permitting drainage of the gastric contents and
insertion of gastric tube. PREVENT ASPIRATION !!!
• tube is designed to separates gastrointestinal and
respiratory tract , thereby protects airway
• The elliptical cuff of the ProSeal extends to the
posterior or the pharyngeal side of the PLMA thus
improving the seal pressure. (Dorsal Cuff)

19. LMA Supreme
• It is a latex free single use LMA similar to the
ProSeal LMA.
• Anatomic curve that facilitates easy insertion
• A drain tube to allow gastric aspiration
• A high volume/ low pressure cuff which
generates higher seal pressure
• An oval airway cross section for improved
stability of the airway

20. LMA CTrach
• conceptualized as an LMA Fastrach with
electronics to allow visualization of the glottic
aperture .
• It has an epiglottis elevating bar, which elevates
the epiglottis during passage of the ETT through
the CTrach™ into the larynx.
• A rechargeable battery is provided for up to 30
minutes of continuous use.

21. PHARYNGEAL SEALERS

22. Laryngeal Tube
• multiuse, latex-free, singlelumen
silicon tube two low pressure cuffs
(proximal and distal).
• The distal balloon (esophageal
balloon) seals the airway distally
• The proximal balloon
(oropharyngeal balloon) seals both
the oral and nasal cavity.
• Two anterior ,oval ventilating vents
between the cuffs.

23. Esophageal–Tracheal Combitube
• Double lumen inserted blindly into
trachea and oesophagus
• Primary tube enters esophagus
• Secondary tube position in pharynx
• Large balloon seals of pharynx
• Small balloon seals off esophagus
• If inserted into trachea , it can act
as ETT

24. Cobra Perilaryngeal Airway
• It is a cuffed pharyngeal sealer
• It is named so because of the widened distal
part resembles the hood of the Cobra
• It has a breathing tube with wide distal end
and a cuff attached to proximal wide
ventilation outlet.
• The cuff when inflated serves to seal off the
distal end from upper airway.
• The wide end lifts tongue, soft tissue and
epiglottis away

25. CUFFLESS PRESHAPED SEALER

26. i-gel
• It is single use SGA
• Made of thermoplastic elastomer
• It mirrors anatomy of airway and
airway seal improves as device
warms to body temperature
• easy to insert

27. streamlined liner of the pharynx (SLIPA)
• The SLIPA is a latex free device and it is shaped like a
slipper
• It is made of medical grade thermoplastic material
that is stiff enough to facilitate easy insertion.
• After insertion it warns up to body temperature and
softens, improving the seal and comfort.
• It has a hollow, chamber similar to a boot in shape.
• There is a toe which sits at the upper end of
esophageal opening, a bridge that comes to rest at
the valeculla
• . Finally, the heel of SLIPA lends stability to the
device by fitting in the nasopharynx.

28. Baska Mask Airway
• It belongs to third
generation
• Gastric port , bite
block,high seal pressure(
proseal LMA)
• Anatomically curved
airway tube (LMA
SUPREME)
• Gel like membranous
diaphragm instead of
inflatable balloon(I-gel)

29. REFERENCE
• Supraglottic airway devices : a knock of future ACCMJ Journal
• ANAESTHESIA Review- A Comprehensive Textbook for the Examinees
• Understanding Anesthetic Equipment & Procedures -A Practical
Approach

30. Thank you!!