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How To Place A Supraglottic

“Stability in Seconds.”

An instructional image demonstrating the placement of a supraglottic airway device, showing a hand holding the device with directional arrows and a depiction of the throat anatomy.
IntroductionUniversal PrinciplesSpecific Devices
LMA PlacementThe King LTiGel Placement
After PlaceementWhat’s Next

The Essentials

Now that you’re familiar with the most common types of SGAs, let’s actually learn how to use them! We will go over how to insert each device momentarily, but first, it’s worth mentioning a few common principles.

Inspirational text emphasizing the quick, blind, and effective placement of SGA types with minimal training.

Universal Technique

The beginning is the same, regardless of the device.

  1. Pick the correct size.
  2. Deflate the cuff (if present).
  3. Apply lubrication to the posterior (dorsal) side of the device.
  4. Position the patient (head-tilt, chin-lift) and scissor the mouth open.
A pair of gloved hands manipulating a syringe and a medical device under water, indicating a medical procedure or demonstration.
An illustration depicting a head-tilt, chin-lift 'sniffing' position for airway management, emphasizing the importance of tongue displacement and relaxed airway geometry.

Universal Insertion Biomechanics:

  • Insert with the tip riding the hard palate → soft palate → hypopharynx.
  • Keep the device midline and rotate only if your device’s technique calls for it
  • Advance until you feel definitive resistance or the depth marker is at the incisors (device-dependent)
Text graphic that reads: 'Universal Rule of SGA Placement: FOLLOW THE PALETE, NOT THE TONGUE.' against a blue background with a water effect.

🎧 Deep Cuts

The essentials give you the foundation.
This is where we sharpen it.

Device Specific Techniques

LMA Placement

Preparation

  1. Position the patient (sniffing or neutral depending on context).
  2. Preoxygenate if possible.
  3. Check cuff integrity (for inflatable models). Deflate the cuff fully into a smooth, flat shape.
  4. Lubricate the posterior surface only (avoid excess lubricant at the tip).
  5. Ensure suction is available.

Holding the Device

This has several benefits:

  1. Controls force & direction of insertion.
  2. Allows you to use your index finger to push the tongue if it gets in your way.

Insertion (Inflatable LMA, Classic Technique)

  1. Open the mouth using a scissor technique.
  2. Insert the device along the hard palate, advancing posteriorly with the curve following the palatopharyngeal contour.
  3. Advance until resistance is felt (mask seated at the hypopharynx).
  4. Inflate the cuff with the recommended volume (do not exceed manufacturer limits).
  5. Connect to ventilation device.

Avoid force. If resistance occurs early, withdraw slightly and re-advance while maintaining midline positioning.

Insertion Technique

Watch this rapid review and longer instructional video. Once you’re ready, head to the hands-on station to practice LMA insertion.

King Airway Placement

While the King Airway is not found very often in a hospital setting, it is still the standard SGA used by many EMS providers, including FDNY! Being able to recognize it, troubleshoot it, and remove it when you feel ready is essential for safe transition from pre-hospital care, to ED resuscitation.

Preparation

  1. Pick size
  2. Check & deflate the cuff.
  3. Lubricate
  4. Position patient.

Insertion:

This is where the King Airway differs from the LMA. Because it’s more rigid, and more bulky, than the LMA, inserting it with your fingers running down the hard palate is difficult.

  1. Open the mouth
  2. Distract the tongue forward with a laryngoscope (or tongue depressor)
  3. Insert king airway at a 45 degree angle until the tip passes the base of the tongue.
  4. Rotate to realign the king airway with the airway axis.
  5. Advance until you feel resistance
  6. Inflate (full amount for both cuffs.

Instead, we recommend using a laryngoscope to displace the tongue and inserting the King Airway via a lateral approach at 45 degrees.

iGel Placement

With no cuff to inflate, the iGel takes simplicity to another level. Not surprisingly, it has become many clinician’s favorite rescue tool.

The steps and maneuvers of insertion essentially follow the same steps as the LMA Classic, but without the cuff.

After Placement

Confirmation That You Are In the Green Zone

Once in place, confirm that adequate oxygen is being delivered to the patient and secure the device. This requires a multi-step confirmation. Never use one metric.

You must be able to confirm:

  • Visible chest rise
  • Bilateral breath sounds
  • Capnography waveform
  • Absence of significant air leak
  • Appropriate airway pressures

If repeated attempts fail or oxygenation is inadequate, initiate optimization strategies to achieve your best effort before proceeding to alternative airway lifelines.

What’s Next

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Infographic titled 'Optimization Essentials of Supraglottic Airway Placement' outlining key steps and techniques for effective airway management, including manipulation, size and type adjustment, suction and oxygen use, adjuncts for insertion, and sedation and paralysis strategies.

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