Recommended Type of Laryngeal Mask Airway for Critically Ill Adults

Introduction to Second-Generation Supraglottic Airway Devices

The British Journal of Anaesthesia recommends using second-generation supraglottic airways, specifically the ProSeal LMA (PLMA), LMA Supreme, or i-gel, for airway rescue in critically ill adults and emergency situations, with the PLMA offering the highest oropharyngeal seal pressure 1, 2

Second-generation SGAs, such as the ProSeal LMA, LMA Supreme, and i-gel, are mandatory for critical care due to their higher oropharyngeal seal pressures and reduced risk of gastric inflation compared to first-generation devices 1, 2, 3
The ProSeal LMA has the highest oropharyngeal seal pressure, followed by the LMA Supreme and then the i-gel 1, 2

The American Heart Association suggests using either an advanced airway or a bag-mask device for cardiac arrest, with no strong preference for a specific LMA type in out-of-hospital settings, but second-generation devices are preferable when an SGA is chosen 4, 5, 6
The French Society of Anesthesia and Intensive Care recommends supraglottic airways over endotracheal intubation for short-duration elective superficial surgery in pediatric patients, with LMA use reducing perioperative respiratory complications 8

Device-specific training is essential to improve success rates and should receive the same emphasis as tracheal intubation training 3
Limit SGA insertion to one optimal attempt or a maximum of three attempts before declaring failure and moving to front-of-neck access 1, 2
Avoid applying cricoid pressure during SGA insertion, as it impairs placement and ventilation 9