Hi there,
My answer comes very late as I only now became aware of this site. LMA in the prone position is a good option...when it is really indicated. Until not very long ago we were afraid of this device used in this position because...we had in fact no idea what to do. The limiting factor, in fact, is that in most of the cases the patien's head was turnes aside so we were concerned of the possible injuries of the brachial plexus in longer procedures. However, if the head/face support allows middle(neutral) head position this is not a problem. Obese people in prone position? Ok, this is a debateble issue, as obesity is a risk factor for regurgitation, so, the LMA should not be used. But otherwise? We live with the impression that an ETT passed between the vocal cords is the safest way to ventilate a prone patient. Why? Because we are the "victims" of the same traditional teaching that is afraid of new things. Take a short search on airway emergency saving procedures in a prone patient and you'll see that in most of the cases the LMA was the best, fastest and most reliable solution. Even in posterior fossa surgery or spine surgery. The prone patient is usually positioned so that the head is slightly angeled down as compared to the thoracal spine. Even if there are secretions, like saliva, they are usually driven down by gravity. Ann, finally, even if there is some aspiration...of what? None would use LMA in non-elective cases, unless in life-saving circumstances. So, what are we talking about? I use the LMA without any problem in laparascopies (cholecyst, hysterectomies), face down short cases, as you mentioned (because in the institution where I work some upper decision persons are not familliar with the method). To the extent of my knowledge no one tried the LMA for, e.g. long spine surgeries, but, in fact, what could be the broblem? I don't see any. Just for your informstion, there are articles describing the insertion of a classic LMA with an NG tube and perfect seal. There is absolutely no problem using NDMR with the LMA. So, in fact, the only difference is that teh LMA is supraglottic. There apperared recently a retrospective study, from Italy, comparing the aspitarion rate while using the ETT and the LMA, over 60000 patients. It seems that the LMA is in a slightly better position. So?
Good luck and don't be afraid. Read, practice and apply. Othewise you'll be mere copies of your techers.