Intubating Laryngeal Airway. Intubating LMA demonstrating an ETT through the device lumen. (Photo contributor: Lawrence B. Stack, MD.)
Intubating Laryngeal Airway Sizes. ILA in five different sizes. (Photo contributor: Lawrence B. Stack, MD.)
Intubating Laryngeal Airway Insertion. The ILA is inserted by displacing the tongue and jaw anteriorly and is advanced down the curvature of the oropharynx and hypopharynx. (Photo contributor: Lawrence B. Stack, MD.)
ETT Insertion Through the Intubating Laryngeal Airway. An ETT is advanced through the ILA. (Photo contributor: Lawrence B. Stack, MD.)
Intubating Laryngeal Airway Removal. Removal of the ILA while keeping the ETT in placed is accomplished by using the disposable tube stabilizer (blue). (Photo contributor: Lawrence B. Stack, MD.)
The reusable ILA is similar in concept to the classic LMA but has structural features that provide easier and more stable insertion with less likelihood of tube kink. In addition, it has a unique “keyhole”-like airway outlet that helps to direct an ETT to the midline at the proper glottic entry angle. Because it has a larger lumen, the ILA can accommodate standard ETT up to 8.5 mm ID. The ILA comes in five sizes—1.0 (<5 kg), 1.5 (10-20 kg), 2.4 (20-50 kg), 3.5 (50-70 kg), and 4.5 (70-100 kg)—accommodating maximum ETT sizes of 4.5, 5.5, 6.5, 7.5, and 8.5, respectively.
The mandible is displaced anteriorly with a jaw lift maneuver, bringing the tongue and epiglottis forward. The ILA is then inserted into the mouth, advancing with a downward and inward force to follow the curve of the oropharynx/hypopharynx. The insertion endpoint is firm resistance to further insertion. The cuff is then inflated with approximately 20 mL of air or until the pilot balloon is firm. Ventilation can proceed by attaching a ventilating bag to the proximal port.
Intubation can be accomplished through the ILA in a well sedated/chemically paralyzed patient after first removing the proximal 15-mm adaptor port. A well-lubricated standard ETT can then be inserted through the ILA. This procedure can also be aided by using a lightwand or optical stylet through the ETT to facilitate optimal alignment for intubation.
Once the ETT is inserted, the ILA can be easily removed by inserting the disposable tube stabilizer/stylet.