Laryngeal mask insertion by standard technique

The standard technique for LMA placement is appropriate for children over 7 years of age. We recommend that clinicians use the rotational technique instead of the lateral or standard technique when placing LMAs in children under 7 years of age. For a description of the LMA rotational technique, refer to UpToDate content on supraglottic airway devices in children.

The standard technique consists of the following steps.

• (A) The deflated and lubricated LMA is held in the operator's dominant hand like a pen or pencil, with the index finger at the cuff as shown.

  (B) The patient's mouth is opened, and the LMA is pressed against the patient's hard palate. The wrist of the operator should remain flexed. If neck movement is not prohibited, placement of the operator's nondominant hand as shown can increase leverage and facilitate placement.

  (C) The LMA mask is pressed inward by extension of the index finger. Contact with the palate is maintained.

  (D) The index finger is pressed toward the nondominant hand to exert counterpressure.

  (E) The LMA cuff is advanced into the hypopharynx until resistance is felt. The operator maintains gentle downward pressure on the tube while removing the index finger from the patient's mouth. Inflate the cuff (not pictured) and assure that the patient can be ventilated.

If the patient cannot be ventilated, first reposition with a jaw thrust. If still unable to ventilate, either partially deflate the cuff and reposition without full removal or fully deflate the cuff, remove, and repeat placement.