• ”Cannot ventilate” sufficiently with bag-valve-mask +/- adjuncts
  • ”Cannot intubate:” LMA is an alternative to endotracheal intubation under direct visualization
  • ”Cannot intubate / cannot ventilate:” rescue measure prior to surgical airway



  • Awake or drowsy patient
  • Mouth opening < 2 cm


  1. Prior
  • Choose a laryngeal mask airway of the correct size
  • Choose a bag of the correct size
  • Deflate the cuff
  • Apply water-soluble lubricant on the posterior surface of the LMA


  1. Procedure
  • Open the patient’s mouth and move the mandible anteriorly
  • Insert the LMA along the hard palate (index-finger insertion technique)
  • Inflate the cuff
  • Attach the bag and ventilate


  1. Post
  • Assess chest movements
  • Assess for air leak around the LMA; adjust the placement of the LMA / air-volume in the cuff / patient’s head position as needed, or replace the LMA with one of a bigger size
  • Assess vital signs (e.g. SpO2%)
  • Fixate the LMA