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Contraindications to the Laryngeal Mask Airway

 

Potential contraindications to the LMA are given in Table 3. Some (e.g., prone position, very long cases) are relative contraindications, and may be safe in the hands of experienced practitioners. Those patients at risk of aspiration should be intubated for airway protection (Nandi and Maltby 1992, Brain 1994). Where PPV with high airway pressures are needed (e.g., stiff lungs, Trendelenburg position), the regular (classic) LMA may leak and result in gurgling in the larynx, leading to concern about possible aspiration. (A new LMA design, the LMA Proseal, appears to eliminate this problem to a large degree.) Where previous oropharyngeal or laryngeal pathology is likely to result in a poor mask fit, the LMA may not function well. Obviously, the LMA cannot be used for some forms of pharyngeal or glottic surgery, as it interferes with surgical access. However, although controversial, LMAs have even been used for tonsillectomy [Webster et al. 1993].

Table 3. Contraindications to elective use of the Laryngeal Mask Airway. (Note: Despite these contraindications, the LMA may still be quite acceptable as a rescue device.)

Absolute Contraindications

  • Full stomach / significant aspiration risk (including hiatus hernia)
  • Morbidly obese patients
  • Untrained in LMA use
  • Oropharyngeal pathology very likely to result in a poor mask fit (e.g., radiotherapy for hypopharynx/larynx)
  • Glottic surgery

Relative Contraindications

  • PPV with AWP > 20 cm H2O (stiff lungs, Trendelenburg position, laparoscopy)
  • Very long cases
  • Prone position

 

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