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Elective ventilation

  • The laryngeal mask airway (LMA) is an acceptable alternative to mask anesthesia in the operating room.
  • It is often used for short procedures when endotracheal intubation is not necessary.
Difficult airway
  • After failed intubation, the LMA can be used as a rescue device.
  • In the case of the patient who cannot be intubated but can be ventilated, the LMA is a good alternative to continued bag-valve-mask ventilation because LMA is easier to maintain over time and it has been shown to decrease, though not eliminate, aspiration risk.
  • In the case of the patient who cannot be intubated or ventilated, a surgical airway is indicated and should not be delayed. However, if the LMA is at hand, it can easily be attempted quickly, while an assistant simultaneously prepares for cricothyroidotomy.
Conduit for intubation
  • The LMA can be used as a conduit for intubation, particularly when direct laryngoscopy is unsuccessful.
Cardiac arrest
  • The 2005 American Heart Association guidelines indicate the LMA as an acceptable alternative to intubation for airway management in the cardiac arrest patient (Class IIa).
  • This may be particularly useful in the prehospital setting, where emergency medical technicians typically have less experience with intubation and lower success rates.

The laryngeal mask airway does not protect the lungs from aspiration, making them unsuitable for patients at risk for this complication.


  1. Static current
    • Generated by flow of gases
    • Methods to prevent, antistatic material (adding carbon) cotton clothes, humidity > 50%
  2. Oxygen delivery devices:
    oxygen providing devices
    Classified on basis of providing their ability to provide adequate flow levels and a range of fraction of inspired oxygen
    1. low flow or variable- performance equipment
      1. usually indicated for patient with stable breathing patterns
      2. MINUTE VENTILATION less than 8-10 L/min
      3. BREATHING FREQUENCY less than 20 breaths /min
      4. Normal inpiratory flow 10-30 l/min
      5. Equipments –
        1. nasal cannulas
        2. simple masks
        3. masks with reservoir
        4. nasal masks
    2. High – FLOW or fixed-performance equipments
      1. usually indicated for patientws who require
      2. consistent FIO2
      3. large inspiratory flows of gas (>40L/min)
      4. Equipments
        • Anaesthesia Bag or Bag and MASK- valve system
        • Air –ENTRAINMENT venture mask (ventimask)
        • Air –entrainment nebulisers
        • Oxygen hoods
        • High flow air – oxygen system
        • Helium –oxygen therapy
      5. Helium is premixed with oxygen in several standard blends
      6. Most popular mixtures are the 80%/20% and 70%/30% helium –oxygen, which has densities that are 1.805 and 1.586 times less than pure oxygen
      7. Uses-
        • for acute upper airway obstruction
        • When smaller ETT IS USED
        • To reduce work of breathing
    3. Hazards of oxygen therapy
      1. hypoventilation
      2. absorption atelectasis
      3. pulmonary toxicity- depends on both partial pressure of oxygen and duration of exposure
      4. retinopathy of prematurity
    4. Reservoir Bag
      1. For neonates - 250 ml
      2. For infant & small children - 500 ml
      3. For adolescents - 1000 ml
      4. For adults - 2000 ml
    5. Oral Airways:
      1. Most commonly used airway - Guedel
      2. Length of airway - Distance between tip of nose & tragus + 1 inch

Combitube - Double lumen (Outer) and inner (small) --> used for emergency air management.


Recent advances-


Newer supraglottic device-

  1. ELISHA airway device- it combines three function- ventilation, blind intubation and gastric tube insertion
  2. COBRA perilaryngeal airway
  3. SLIPA (Streamlined pharynx airway liner)

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