Laryngeal mask insertion by standard technique

(A) The LMA is held in the operator's dominant hand like a pen or pencil, with the index finger at the cuff as shown.
(B) The patient's mouth is opened, and the LMA is pressed against the patient's hard palate. The wrist of the operator should remain flexed. If neck movement is not prohibited, placement of the operator's nondominant hand as shown can increase leverage and facilitate placement.
(C) The LMA mask is pressed inward by extension of the index finger. Contact with the palate is maintained.
(D) The index finger is pressed toward the nondominant hand to exert counterpressure.
(E) The LMA cuff is advanced into the hypopharynx until resistance is felt. The operator maintains gentle downward pressure on the tube while removing the index finger from the patient's mouth.