A laryngeal mask airway (LMA) is an option when bag-mask PPV is ineffective, and intubation is delayed. The LMA has an inflatable cushion on the inferior end that covers the glottis and forms a seal against the hypopharynx. The superior portion of the LMA connects directly to any PPV device. Air flow through the LMA is directed toward the trachea and away from the esophagus. LMA insertion is a blind procedure and requires only the LMA and a syringe to inflate the cushion once the LMA is in place.

Size 1 laryngeal mask airway for use in newborns.

Newborns with congenital anomalies of the mouth, tongue, palate, or neck who require PPV are best suited to PPV via an LMA rather than a face mask. It may be impossible to achieve a good seal on patients with these anatomical anomalies using a face mask. 

Infants with a small mandible and a big tongue (e.g., babies with trisomy 21 or Robin sequence) will also benefit from a laryngeal mask if they require PPV. Endotracheal intubation may be difficult with these patients, so PPV via an LMA may be quicker and safer. 

The LMA has some disadvantages relative to intubation with an ET tube. Suctioning secretions is not possible through an LMA. Additionally, if high pressures are needed, the seal surrounding the mask may leak. Finally, the smallest LMA currently available is only appropriate for use with infants > 2,000 g.

Provider inserting a laryngeal mask airway.⁹

Before inserting a laryngeal mask airway, the provider attaches a syringe to the inflation port and deflates the cuff. The vacuum created in this way causes the mask’s cushion to form a wedge shape. The back of the mask can be lubricated with a water-based lubricant. The clinician stands at the baby’s head and positions the baby’s head in the sniffing position. 

After opening the baby’s mouth and pressing the tip of the mask against the baby’s hard palate, the clinician advances the tube inwards with a gentle circular motion until resistance is felt. The resistance signifies that the mask is at the level of the hypopharynx. The cuff is then inflated to hold the tube in place. The clinician should follow the manufacturer’s recommendation regarding the volume of air needed to inflate the laryngeal mask. 

Once the LMA is in place, the superior end is attached to any PPV device. Waterproof adhesive tape can be used to keep the tube in place. Proper placement of the LMA can be confirmed with an ETCO₂ detector. The LMA is well-positioned if the ETCO₂ detector changes color from purple to yellow. 

Once the baby establishes adequate spontaneous respirations, the LMA can be removed. If additional respiratory interventions are necessary, the infant can be placed on CPAP. Secretions must be suctioned out from the mouth and throat before deflating the laryngeal mask and removing the tube to avoid aspiration.

The laryngeal mask can cause trauma in the airway soft tissues. It can also cause laryngospasm and gastric distention from air leakage around the mask.