Decision-Making of CRNAs Related to Use of Laryngeal Mask Airways

Improper airway management is a major concern in anesthesia care. Today the laryngeal mask airway (LMA) has a well-established role in anesthesia practice. It is widely used, but there are certain situations where anesthesia providers are hesitant to use the LMA. The purpose of this study was to evaluate the factors that influence the decision-making process of CRNAs regarding the use of an LMA versus an endotracheal tube. The design of this exploratory study was qualitative and 11 CRNAs participated in semi-structured interviews. Results showed that all participants received formal training with an LMA and were most likely to be using it when the case did not require the use of neuromuscular blocking agents (63%) and during short procedures of less than an hour (18%). The major concern associated with use of the LMA was aspiration. Sixty three percent (n=7) identified no barriers to the use of the LMA, two CRNAs (18%) identified the types of LMAs available, and one CRNA (9%) identified surgeon/anesthesiologist preference as barriers. As an APRN, the CRNA incorporates research and evidence-based practice to achieve optimal outcomes. To date, there is no specific practice guideline that solely pertains to the placement of an LMA versus an ETT. The CRNA must make clinical decisions utilizing the algorithms that do exist such as the ASA’s Difficult Airway Algorithm. Choosing an LMA or ETT requires a thorough evaluation of several factors and the decision to use an LMA is often based on personal experience and judgment of the CRNA. Further research is needed