Relationship Between Supraglottic Airways and Laryngeal Mask Airways
A laryngeal mask airway (LMA) is a specific type of supraglottic airway device—the LMA is not different from a supraglottic airway, but rather represents the original and most well-known example within this broader device category. 1
Understanding the Terminology
Supraglottic airway (SGA) is the umbrella term for an entire class of airway devices designed to maintain an open airway and facilitate ventilation without requiring visualization of the glottis or passage through the vocal cords. 1
The laryngeal mask airway (LMA) was the pioneering device in this category, first described by Brain in 1983, and it revolutionized airway management in anesthesia. 2 The LMA became so successful that it essentially defined the category, but it is just one specific brand and design among many SGAs now available.
The Full Family of Supraglottic Airways
According to the 2010 American Heart Association guidelines, supraglottic airways studied in cardiac arrest include: 1
- Laryngeal mask airway (LMA) - the original device and its variants
- Esophageal-tracheal tube (Combitube)
- Laryngeal tube (King LT)
Modern practice has expanded to include numerous other SGAs beyond these original devices. 2
Evolution and Generations
The terminology has further evolved to distinguish between:
- First-generation SGAs: The classic LMA and similar basic designs without additional safety features
- Second-generation SGAs: Newer devices like the LMA ProSeal, LMA Supreme, i-gel, and others that offer improved oropharyngeal seal pressure and gastric access ports for aspiration risk reduction 3, 4, 5
Clinical Implications
All LMAs are supraglottic airways, but not all supraglottic airways are LMAs. This distinction matters because:
- Different SGAs have varying performance characteristics for oropharyngeal leak pressure, insertion success rates, and complication profiles 6, 7
- The 2022 ASA Practice Guidelines recognize multiple SGA options as acceptable alternatives to endotracheal intubation and bag-mask ventilation 8
- Device selection should be based on specific clinical needs, with second-generation devices preferred when aspiration risk or positive pressure ventilation requirements are concerns 3, 9
Common pitfall: Clinicians sometimes use "LMA" generically to refer to any supraglottic airway, but this is imprecise. The LMA is a specific brand (originally manufactured by Teleflex), while many other manufacturers produce different supraglottic airway designs with distinct features and performance characteristics.