Algorithm of Berry et al for Selecting the Size of Laryngeal Mask Airway (LMA) for a Normal Adult

 

Initial Selection	Size #4	Size #5
gender	female	male
body weight		> 45 kilograms
height	< 165 cm	>= 165 cm

from Figure 1, page 570

 

where:

• I am not sure if this algorithm would work in the elderly. The oldest patient in the study was 68 years old.

 

After proper insertion into the patient, inflate the cuff with 7-10 mL of air.

 

If the oropharyngeal leak pressure (OLP) is >= 15 cm H2O then the seal is adequate.

 

If the oropharyngeal leak pressure is < 15 cm H20, then trying the following interventions:

(1) add an additional 5-10 mL to the cuff

(2) increase the size of the LMA and repeat cuff inflation (a size #6 may be appropriate for large males)

(3) apply anterior neck pressure then release

 

If none of these is successful in increasing the OLP to >= 15 cm, then consider an alternative airway.