How To Insert a Laryngeal Mask Airway VIDEO Indications for Laryngeal Mask Airway Insertion Apnea, severe respiratory failure, or impending respiratory arrest in which endotracheal intubation cannot be accomplished Certain elective anesthesia cases LMAs are useful in situations where bag-valve-mask ventilation is difficult: Patients with severe facial deformity (traumatic or natural), thick beard, or other factors that interfere with the face mask seal Contraindications to Laryngeal Mask Airway Insertion Absolute contraindications There is no medical contraindication to providing ventilatory support to a patient; however, a legal contraindication (do-not-resuscitate order or specific advance directive) may be in force Maximum mouth opening between incisors < 2 cm (nasotracheal intubation or a surgical airway would be indicated in this case) Impassable upper airway obstruction (surgical airway would be indicated in this case) Relative contraindications Consciousness or presence of a gag reflex (patients should be unconscious or receive drugs to aid intubation, such as a sedative and a paralytic agent, prior to LMA insertion) Increased risk of regurgitation in patients with prolonged prior BVM ventilation, obesity, pregnancy > 10 weeks, upper gastrointestinal issues (eg, previous surgery, bleeding, hiatal hernia, gastroesophageal reflux disease, peptic ulcer disease), and in patients who have not fasted.