LMA placement by the rotational technique is recommended for infants and young children <7 years old. The technique is as follows:
- Select an appropriately sized LMA and remove it from its packaging; partially inflate the cuff until all indentations are gone.
- Lubricate the cuff with water-soluble lubricant. Stand at the patient's head as for a standard intubation.
- Open the child's mouth using your non-dominant hand (panel A).
- Using your dominant hand, insert the LMA with the opening facing the palate until resistance from the posterior pharyngeal wall is felt (panels A and B).
- Rotate the LMA 180 degrees and pass it downward into position behind the larynx (panels C and D).
- Attempt bag ventilation. If the patient can be properly ventilated, fully inflate the cuff. No further action is necessary. If not or if there is a significant air leak, the LMA must be removed or repositioned.
