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A I R W A Y
M A N A G E M E N T
breathing. For a time, anesthesia
of time it took to insert or remove
providers assumed that using LMAs
each device.
was a faster technique, that they'd be
able to remove them from patients'
airways sooner. Residents who visit
our ASC on their rotations think that if
4
Time the technique
When you administer anesthesia
is just as important as which
agent you use in determining how
they do all their cases with LMAs,
quickly patients wake and sponta-
they'll be out faster. "Not true," I'll say,
neously breathe, and how soon you
before directing them to the study by
can remove an artificial airway. Your
Girish P. Joshi, MBBS, MD, FFARCSI,
anesthetic technique at the beginning
et al., in the September 1997 issue of
of a case should have the end in mind.
the journal Anesthesia and
Analgesia
(tinyurl.com/ml3cess).
In a comparison between
tracheal intubation and
LMA use, Dr. Joshi and his
colleagues found that LMAs
were useful for ambulatory
anesthesia and airway management, largely because
END IN MIND The goal of any anesthetic technique is to get
patients breathing spontaneously as soon as possible after surgery.
they didn't result in the high
incidence of sore throats and patient
For example, if it's necessary to give
complaints often associated with ET
long-acting opioids, such as morphine,
tubes. Granted, patient comfort is a
give them at the beginning of the case.
big score. But they saw no significant
Toward the end of the case, short-act-
difference between the number of
ing narcotics like fentanyl can be
placement attempts and failures for
administered. Among the inhalational
each method, the amount of drugs
agents, sevoflurane and desflurane
administered to patients or the length
have faster uptake and elimination,
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