Advanced Airway Techniques

There are two advanced airway interventions, namely insertion of a supra-glottic airway (laryngeal mask or I-gel) and endotracheal intubation. Endotracheal intubation is the gold standard airway intervention, avoiding gastric insufflation, protecting the airway from soiling and allowing high ventilation pressures if required. However, this technique requires an experienced practitioner, and must only be performed by those who have demonstrated proficiency, and have a mechanism in place to ensure skill retention. Further discussion of this is beyond the scope of this text.

Laryngeal mask Airway

The laryngeal mask airway (LMA) is an elliptical cuff positioned on the end of a tube. The cuff is designed to sit over the tracheal inlet. As such, it provides some protection against aspiration and will reduce gastric insufflation. However, neither of these are absolute and the airway must not be regarded as protected. Insertion of the laryngeal mask is relatively simple and the technique is easily taught. This is the key advantage of the laryngeal mask over formal endotracheal intubation.

I-gel airway

The I-gel is similar to the LMA but the air filled cuff is replaced by a gel cuff. This removes the potential problem of the air filled cuff being torn and also simplifies the insertion procedure. The gel cuff provides some protection against aspiration and will reduce gastric insufflation. In addition there is a suction port.

Insertion of an I-gel airway