Airway management using the laryngeal mask (LMA)

   The laryngeal mask has been a major advance for airway management, reducing post-op coughing, nausea and vomiting for most of my cases. The device (left photo) is positioned above the larynx in the posterior pharynx and is sealed with an air cuff. It is not passed through the vocal cords like endotracheal tubes. Positioning and removal are accomplished quickly and easily - vital signs rarely change while the device is adjusted. The patient generally breathes spontaneously during the case (right photo). "Bucking the tube," something we observed fairly commonly with endotracheal tubes (requiring deeper anesthesia to  blunt the cough reflex) almost never occurs. Patient acceptance of and preference for using the LMA has been uniformly positive.

   There are relative contraindications to using this device, including reflux esophagitis and decreased lung compliance (a problem for some adults with chronic lung diseases, particularly related to cigarette smoking). These problems are relatively unusual in my patient population, so we are able to use an LMA for the vast majority of my procedures.