To List Members:
In reference Dr. Kirelik's question on the use of Laryngeal Mask Airways
(LMA) for failed intubation I would highly recommend including and using
these devices. We have used them in our department and found them
excellent for failed RSI attempts. In many institutions the
anesthesiologists use LMA instead of intubations in children, especially
infants in the operating room.
There is a new modification of the LMA for larger children and adults
(sizes 3-5) which is designed specifically for passage of an endotracheal
tube without the use of a fiberoptic scope. We've tried these on models
but not on patients and they are very very slick.
A couple of points on using LMAs. When first placed they may take a breath
or two to settle in properly, so don't be concerned if you suspect a leak
initially. Also, they will leak with rapid high pressure ventilation (i.e.
the type of panic bag squeezing that occurs immediately after placement of
a difficult ET tube). We've mistakenly pulled properlly placed LMAs
because of this. The last thing I would recommend is to use a continous
quantitative capnometer with the LMA. The reassurance of seeing an end
tidal wave form will help convince you that you are truly ventilating a
patient with the LMA.
One final point is that a number of trauma centers are now going to LMAs
for difficult intubations with suspected cervical spine injuries.
From the prospective of someone with enough experience to know that there
are patients who you will not realize you cannot intubate until after you
have administed the paralytic, having an LMA as another tool in the
difficult airway bag of tricks is very reassuring.
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