**2. Clinical indications of LMA**

#### **2.1 As a substitute for a facemask**

LMAs are especially useful when mask fit is difficult as in edentulous or bearded patients. It also frees the hands of the anaesthesia care giver.

#### **2.2 As an alternative to tracheal intubation for routine anaesthesia**

The LMA may be used in the spontaneously breathing patient with adequate sedation and topical anaesthesia, or the paralysed, anaesthetised patient with assisted mechanical ventilation.

#### *2.2.1 Laparoscopic surgery*

The indications for use of the supraglottic airway devices are expanding. Their routine use in laparoscopic surgeries has almost replaced the endotracheal tubes. Second generation SGAs have proved to provide adequate sealing pressure required to provide adequate ventilation and maintain airway safety [8]. Also, pharyngolaryngeal morbidity (sore throat, dysphagia, dysphonia) are less as compared to endotracheal tube [9, 10].

#### *2.2.2 Obese patients*

In today's era, the number of obese patients undergoing surgeries is increasing. Intubation is known to be more difficult in obese patients [11, 12]. Closed claims analysis shows that obesity, difficult intubation and intubation by inexperienced personnel are risk factors for severe airway injuries and pharyngo-oesophageal perforation [13].

In such cases, SGAs after successful placement can provide better postoperative pulmonary performance if used in very well selected patients. Hence, SGAs may be a simple alternative to intubation in short-term elective surgery in obese patients, as suggested by some randomised controlled trials (RCTs) [14]. These maybe used as conduits for tracheal intubation in obese patients with failed laryngoscopy and expected/unexpected difficult airways [15].

#### *2.2.3 Pregnancy*

have been added to the anaesthesiologist's armamentarium to address specific needs. A wide variety of airway devices are available today which are employed to

In 2001, Dr. Archie Brain came up with a modification of the LMA. This device was called the Proseal-Laryngeal mask airway™ (Teleflex®, USA) [7]. This double lumen, double cuff LMA has some clear advantages over its predecessor. The double tube design separated the respiratory and alimentary tracts, providing a safe

Since then, several devices that are able to accommodate nasogastric tubes have been invented. Newer features like better sealing pressures, reduced risk of pulmonary aspiration by stomach contents, single use devices, integrated bite blocks, and the ability to act as conduits for endotracheal tube (ETT) placement have rendered these devices more reliable for routine use. The last decade has seen a rapid rise in

LMAs are especially useful when mask fit is difficult as in edentulous or bearded

The LMA may be used in the spontaneously breathing patient with adequate sedation and topical anaesthesia, or the paralysed, anaesthetised patient with

The indications for use of the supraglottic airway devices are expanding. Their routine use in laparoscopic surgeries has almost replaced the endotracheal tubes. Second generation SGAs have proved to provide adequate sealing pressure required to provide adequate ventilation and maintain airway safety [8]. Also, pharyngolaryngeal morbidity (sore throat, dysphagia, dysphonia) are less as compared to

In today's era, the number of obese patients undergoing surgeries is increasing. Intubation is known to be more difficult in obese patients [11, 12]. Closed claims analysis shows that obesity, difficult intubation and intubation by inexperienced personnel are risk factors for severe airway injuries and pharyngo-oesophageal

In such cases, SGAs after successful placement can provide better postoperative pulmonary performance if used in very well selected patients. Hence, SGAs may be a simple alternative to intubation in short-term elective surgery in obese patients, as suggested by some randomised controlled trials (RCTs) [14]. These maybe used as conduits for tracheal intubation in obese patients with failed laryngoscopy and

protect the airway in both elective as well as emergency situations [6].

the number of clinical studies evaluating these second-generation SGAs.

patients. It also frees the hands of the anaesthesia care giver.

**2.2 As an alternative to tracheal intubation for routine anaesthesia**

escape channel for the regurgitated fluids.

*Special Considerations in Human Airway Management*

**2. Clinical indications of LMA**

**2.1 As a substitute for a facemask**

assisted mechanical ventilation.

*2.2.1 Laparoscopic surgery*

endotracheal tube [9, 10].

*2.2.2 Obese patients*

perforation [13].

**250**

expected/unexpected difficult airways [15].

Maternal morbidity from failed intubation and aspiration remains the biggest concern with general anaesthesia. SGAs can be lifesaving in caesarean deliveries where scenarios of cannot ventilate and cannot intubate is faced. Second generation SGAs have become the gadget of choice in such scenarios [16–18].

### *2.2.4 Paediatric age group*

Being user-friendly, SGAs are now more commonly used in children. They obviate the use of ETTs and avoid many complications associated with endotracheal intubation [19, 20]. The LMA Classic™ and the LMA Proseal™ have established their safety and efficacy for routine as well as in emergency cases in paediatric patients [21–25]. The presence of a drain tube, which helps to empty the stomach in the Second-generation SGAs, has removed the fear of distension of the stomach with gas during controlled or spontaneous ventilation, leading to impairment of respiration, especially in a smaller child.
