Is it safe to leave a Laryngeal Mask Airway (LMA) in place with no supplemental oxygen or ventilation support while transporting a patient to the Post-Anesthesia Care Unit (PACU)?

Leaving an LMA in Place During Transport to PACU

No, an LMA should not be left in place without supplemental oxygen or monitoring during transport to PACU—this practice violates fundamental safety guidelines and significantly increases the risk of hypoxemia and airway complications.

Critical Safety Requirements During Transport

Oxygen Administration is Mandatory

• Supplemental oxygen must be administered during patient transportation when an airway device remains in place 1
• Studies demonstrate that transporting patients with LMAs in situ without oxygen supplementation results in clinically significant hypoxemia, with oxygen saturations dropping below 95% in 56.6% of cases and critically below 90% in 13.3% of cases 2
• The ASA guidelines support using supplemental oxygen during transportation to reduce the incidence of hypoxemia 1

Continuous Monitoring is Required

• Continuous pulse oximetry and monitoring must be maintained throughout transport when an airway device is in place 3, 4
• An appropriately trained staff member must accompany the patient during transport 1
• The patient should be breathing room air only after the LMA is removed and full consciousness is achieved 2

Proper LMA Management Protocol

Timing of LMA Removal

• LMAs should typically be removed in the operating room once the patient is awake, rather than being transported to PACU with the device in place 2
• If the LMA must remain during transport, the patient requires one-to-one observation by trained personnel with immediate availability of an anesthetist 1, 3

PACU Handover Requirements

• When patients arrive in PACU with an LMA in place, the PACU nurse must be specifically trained in management and removal of supraglottic airway devices 1, 5
• An anesthetist must be immediately available to assist if problems occur while the airway device is in place or during removal 1
• The responsibility for LMA removal belongs to the anesthetist, though it may be delegated to appropriately trained PACU staff who accept this responsibility 1

Why This Practice is Dangerous

Hypoxemia Risk

• Patients with LMAs in place who are not fully conscious have significantly impaired airway protective reflexes 1
• Without supplemental oxygen, the risk of clinically relevant desaturation increases dramatically during the transport period 2
• The combination of residual anesthetic effects, supine positioning, and lack of oxygen creates a perfect storm for respiratory compromise 1

Airway Obstruction Risk

• Poorly positioned airway devices can cause upper airway obstruction 5
• Without continuous monitoring, early signs of obstruction (stridor, increased work of breathing) may go unrecognized 5
• LMA displacement during transport can cause severe complications including bradycardia from carotid sinus compression 6

The Correct Approach

If Transport with LMA is Unavoidable

1. Administer 100% oxygen via the LMA throughout transport 1
2. Maintain continuous pulse oximetry monitoring 3
3. Ensure trained personnel accompanies the patient 1
4. Have the anesthetist immediately available upon PACU arrival 1
5. Insert a bite block to prevent LMA damage 1
6. Position patient appropriately (typically upright if tolerated) 1

Preferred Alternative

• Remove the LMA in the operating room once the patient is awake and has regained airway reflexes, then transport with supplemental oxygen via face mask 2
• This approach eliminates the risks associated with transporting a patient with an in-situ airway device while not fully conscious 1

Common Pitfall to Avoid

The most dangerous assumption is that a patient with an LMA in place has a "secured airway" that requires no additional support. An LMA is not equivalent to an endotracheal tube—it does not protect against aspiration, can easily become displaced, and requires the patient to have adequate respiratory drive and airway reflexes 7. Leaving it in place without oxygen or monitoring during transport represents a critical lapse in basic airway management principles 1.