Laryngeal Mask Airway Misplacement

Anesthesia Complications & Medical Malpractice

Laryngeal mask airways (LMAs) are medical devices designed to keep a patient’s airway open during unconsciousness or a state of sedation. It was developed as an alternative to endotracheal intubation. While intubation pushes the breathing tube down the glottis into the trachea (which is where the windpipe branches into the two lungs), LMAs place an airtight seal at the top of the glottis, above the trachea. LMAs also block the esophagus, preventing air from inflating the stomach.

The LMA is used in a variety of medical situations, including cases of cardiac arrest or in short procedures where intubation isn’t necessary. Because the LMA is easier for inexperienced practitioners to insert accurately, it’s also used in emergency or pre-hospital settings. An LMA can also be used as a guide for endotracheal intubation.

LMA & Anesthesia

Placing the LMA often requires sedation to ensure proper insertion. Without proper sedation, there are a number of potential complications—particularly laryngospasm during placement. Patients vulnerable to coughing or moving involuntarily may also cause the LMA to be improperly placed. In these cases or in cases involving pediatric patients, a deeper state of sedation would be necessary. When patients are not sedated enough, the doctor or medical provider is more likely to misplace the LMA.

LMA misplacement increases the likelihood of:

  • Airway obstruction
  • Stomach aspiration
  • Local irritation
  • Nerve palsies and lesions
  • Mild sympathetic (involuntary) response
  • Laryngospasm (causing breathing difficulties)

One study found that misplacement occurred in .15% of procedures, with a higher rate more likely in emergency situations. The complications of misplacement include dysphonia (difficulty speaking) and dysphagia (difficulty swallowing) in some reported cases. Doctors believe that the cuff can sometimes damage or paralyze the vocal cords.

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