As the cLMA is inflated it will rise out of the mouth by 0.5-1.5 cm. This is normal as the tip is inflated and should not be inhibited. The anterior neck should fill symmetrically and the posterior longitudinal black line on the cLMA should remain in the anatomical midline (Fig 1). If it does not, this suggests cLMA rotation and misplacement.

As you gently ventilate by hand:

• Look for easy chest rise and fall
• Listen for leaks. At low pressure these may indicate poor positioning. The cLMA may not be adequate if you plan controlled ventilation
• Feel the anaesthetic reservoir bag. Inspiration should be low resistance when the cLMA is correctly positioned. Equally important, the bag should refill rapidly as the patient expires through an unobstructed airway

The anaesthetic bag refills from patient expiration, not fresh gas flow. With experience the 'feel' of refilling is the best indicator of the airway quality, as minor degrees of obstruction/malposition significantly delay expiration.