Which airway device carries a higher risk of aspiration?

• A. LMA
• B. Endotracheal tube
• C. Nasal airway
• D. Oropharyngeal airway

Answer: (A)

Aspiration risk hinges on whether the device protects the lower airway from regurgitated stomach contents. An endotracheal tube with a cuff seals the trachea, isolating the lungs from the esophagus and stomach, so it offers the best protection against aspiration. A laryngeal mask airway sits above the glottis and forms a seal there, but it does not protect below the vocal cords. If contents reflux, they can bypass this seal and reach the lungs, increasing aspiration risk compared with an endotracheal tube. The nasal and oropharyngeal airways keep the airway open but do not provide airway protection against aspiration at all. Therefore, the device that carries a higher risk of aspiration is the one that lacks a reliable barrier to reflux entering the lungs.