*7.3.2.2 Device description, technical aspects and practicalities of use*

The SLMA has following components (**Figure 8**):


**Figure 5.** *PLMA cuff deflator.*

*Second Generation Supraglottic Airway (SGA) Devices DOI: http://dx.doi.org/10.5772/intechopen.93947*

**Figure 6.** *pLMA with insertion tool.*

The pLMA is accompanied by a cuff deflator (**Figure 5**) and insertion tool (**Figures 6** and **7**). The cuff deflator assists complete deflation and flattening the

**Patient weight Maximum cuff volume**

*Special Considerations in Human Airway Management*

**of air (ml)**

1 Neonates/infants up to 5 kg 4 8 3.5 1.5 Infants 5–10 kg 7 10 4 2 Infants/children 10–20 kg 10 10 4.5 2.5 Children 20–30 kg 14 14 5 3 Children 30–50 kg 20 16 6 4 Adults 50–70 kg 30 16 6 5 Adults 70–100 kg 40 18 7

**Gastric tube size (French)**

**Largest ETT ID (mm)**

LMA Supreme™(Teleflex®, USA) is a second generation, single use, SGA device which facilitate ease of placement and in-situ airway stability. It forms an effective seal first with the oropharynx (oropharyngeal seal) and a second seal with the upper oesophageal sphincter (the oesophageal seal). This devise is designed incorporating features of a cLMA, pLMA, and LMA Fastrach [64–66]. SLMA delivers measured oropharyngeal leak pressures up to 37 cm H2 O [67].

device tip before insertion to improve insertion success.

*7.3.2.2 Device description, technical aspects and practicalities of use*

The SLMA has following components (**Figure 8**):

*7.3.2 The LMA-supreme™ (SLMA)*

*7.3.2.1 Introduction*

*Available Proseal LMAs.*

**Mask size**

**Table 3.**

• Modified cuff

• Drain tube

**Figure 5.** *PLMA cuff deflator.*

**260**

• Elliptical airway tube

**Figure 7.** *Insertion tool.*

**Figure 8.** *Parts of LMA supreme.*


The device is preformed and anatomically shaped. The stiffness of SLMA is intended to guide the airway into the correct position during insertion (**Figure 9**). This also eliminates the need for placing the clinician's fingers into the patient's mouth. Also, rotational mal-positioning of the airway becomes unlikely owing to this feature. The integrated bite block reduces the potential for damage to, or obstruction of the airway tube in the event of biting. The airway also has a fixation tab designed to facilitate easy fixation and improve drain tube position. These improvisations render it suited for inexperienced users in an emergency situation.

Primarily, the SLMA has been recommended for securing airway in routine and emergency surgical procedures. It may also be used to secure an immediate airway when tracheal intubation is precluded by lack of available expertise or equipment, or when attempts at tracheal intubation have failed.

fingers wide (index, middle, ring and little fingers), they suggest size 4 SLMA; If it is three fingers wide (index, middle, ring fingers), they suggest size 3 SLMA [71].

**Patient weight Maximum cuff volume of air**

*Second Generation Supraglottic Airway (SGA) Devices DOI: http://dx.doi.org/10.5772/intechopen.93947*

1 Neonates/infants up to 5 kg 5 6 1.5 Infants 5–10 kg 8 6 2 Infants/children 10–20 kg 12 10 2.5 Children 20–30 kg 20 10 3 Children 30–50 kg 30 14 4 Adults 50–70 kg 45 14 5 Adults 70–100 kg 45 14

**(ml)**

**Gastric tube size (French)**

The Guardian laryngeal mask airway™ (GLMA) (Teleflex®, USA) is a new disposable silicone SGA device. The cuff forms a seal with the glottis for ventilation, and with the hypopharynx for airway protection. The gastric drainage port helps to suction the stomach contents. Also, it has a port for suctioning material from the hypopharynx. The pilot balloon valve with pressure logo indicates visual intracuff pressure (Yellow <40 cmH2O, Green 40–60 cmH2O and Red >60 cmH2O) (**Figure 10**). A study suggests that it provides sealing pressures as high as 32 cm

*7.3.3 The LMA Guardian™ (GLMA)*

*7.3.4 LMA protector and LMA protector™ cuff pilot™*

The LMA-Protector™ (Teleflex®, USA) is a novel SGA made of medical-grade silicone (**Figure 11**). In comparison to other devices made of

H2O [72, 73].

**Figure 10.** *LMA guardian.*

**263**

**Mask size**

**Table 4.**

*Available supreme LMAs.*

*7.3.4.1 Introduction*

There is increasing evidence that suggests that it may be used for airway rescue in emergency situations and in hostile environments, particularly when tracheal intubation may be challenging or may delay oxygenation [68–70].

#### *7.3.2.3 Size selection, practical aspect, adjuncts*

Size 1 to 5 are commercially available (**Table 4**). A weight-based size selection is suggested by the manufacturer. The cuff is inflated with air as recommended for that specific size. The intra-cuff pressure should never exceed 60 cm H₂O. The cuff should be inflated with just enough air to achieve a seal sufficient to permit ventilation without leaks, if no manometer is available.

Some studies advocate an anatomical-related size selection method. The patient's thyromental distance is measured by the palm side of patient's hand. If it is four

**Figure 9.** *LMA supreme in-situ.*

*Second Generation Supraglottic Airway (SGA) Devices DOI: http://dx.doi.org/10.5772/intechopen.93947*


#### **Table 4.** *Available supreme LMAs.*

• Integrated bite block

• Fixation tab

**Figure 9.**

**262**

*LMA supreme in-situ.*

• Inflation line with pilot balloon

*Special Considerations in Human Airway Management*

or when attempts at tracheal intubation have failed.

*7.3.2.3 Size selection, practical aspect, adjuncts*

lation without leaks, if no manometer is available.

intubation may be challenging or may delay oxygenation [68–70].

The device is preformed and anatomically shaped. The stiffness of SLMA is intended to guide the airway into the correct position during insertion (**Figure 9**). This also eliminates the need for placing the clinician's fingers into the patient's mouth. Also, rotational mal-positioning of the airway becomes unlikely owing to this feature. The integrated bite block reduces the potential for damage to, or obstruction of the airway tube in the event of biting. The airway also has a fixation tab designed to facilitate easy fixation and improve drain tube position. These improvisations render it suited for inexperienced users in an emergency situation. Primarily, the SLMA has been recommended for securing airway in routine and emergency surgical procedures. It may also be used to secure an immediate airway when tracheal intubation is precluded by lack of available expertise or equipment,

There is increasing evidence that suggests that it may be used for airway rescue in emergency situations and in hostile environments, particularly when tracheal

Size 1 to 5 are commercially available (**Table 4**). A weight-based size selection is suggested by the manufacturer. The cuff is inflated with air as recommended for that specific size. The intra-cuff pressure should never exceed 60 cm H₂O. The cuff should be inflated with just enough air to achieve a seal sufficient to permit venti-

Some studies advocate an anatomical-related size selection method. The patient's thyromental distance is measured by the palm side of patient's hand. If it is four

fingers wide (index, middle, ring and little fingers), they suggest size 4 SLMA; If it is three fingers wide (index, middle, ring fingers), they suggest size 3 SLMA [71].
