ANESTESI

UMUM
DENGAN LMA
Supraglottic Airway
Devices

The supraglottic airway
term

(SGA) or extraglottic airway

refers to a diverse family of medical devices that are
blindly inserted into the
pharynx to provide a patent
conduit for ventilation,
oxygenation, and delivery of
anesthetic gases without the
need for tracheal intubation.
Miller, 2015
Cont’d


SGAs have the advantage of being less
invasive than endotracheal intubation while
providing a more definitive
airway than a facemask, and
can be used for either spontaneous

ventilation or PPV.
 One of the first SGAs, the LMA, was described in 1983
by Dr. Archie Brain and introduced into clinical practice
in 1988.
Miller, 2015
Advantages for SGAs

 The specific advantages of SGAs

include :
1. the ease and speed of placement,
2. improved hemodynamic stability,
3. reduced anesthetic requirements,
4. lack of a need for muscle relaxation,
5. and an avoidance of the risks of tracheal
intubation (e.g., trauma to the teeth and
airway structures, sore throat, coughing
on emergence, bronchospasm). Miller, 2015
Dis-advantages

 The primary disadvantages are that SGAs have

comparatively smaller seal
pressures than ETTs, which can lead to
ineffective ventilation when higher
airway pressures are required, and
they provide no protection from
laryngospasm.
 First-generation SGAs also provide little
protection from gastric
regurgitation and aspiration, although
newer devices have incorporated design Miller, 2015
elements to minimize this risk.
Indications &
Contraindications

Longnecker, 2012
Longnecker, 2012
 LMs reduce dead space ventilation compared
with face mask ventilation.
 If reasonable airway pressures are used and the
mask is correctly positioned, gastric inflation is
unlikely.
 Use of a LM or any SAD enables
anesthesiologists to have their hands free for
other tasks.
 Compression of the eyes and facial and
infraorbital nerves is avoided, and operating
room pollution from anesthetic gases is
reduced. Benumof,
2013
 Compared with ETTs, LMs are easier to place, do not
require laryngoscopy and its associated problems, and
are less invasive.
 Insertion does not require the use of muscle relaxants.
 Insertion causes negligible cardiovascular stimulation,
and increases in intraocular pressure are minimal at
insertion and removal.
 Removal of LMs can be delayed until the patient is fully
awake with the return of protective airway reflexes.
 Coughing and hypoxia occur less frequently compared
with removal of an ETT.

Benumof,
2013
References

 Longnecker, D., et al. 2012. Anesthesiology 2nd

ed. Mc Graw Hill.
 Benumof and Hagberg. 2013. Benumof and
Hagberg’s Airway Management 3rd ed. Elsevier.
 Miller, RD., 2015. Miller’s Anesthesia 8th ed.
Elsevier
TERIMA
KASIH