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How Do You Measure Up? - October 2013 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 72 of 118

OS_1310_part2_Layout 1 10/7/13 10:26 AM Page 73 A I R W A Y M A N A G E M E N T The LMA also provides a conduit for intubation, because the opening of the device usually rests directly above the vocal cords and glottis. In patients with poor dentition, the LMA allows placement of a secure airway without requiring the use of a laryngoscope, potentially limiting iatrogenic periodontal trauma. LMAs can be used in almost all types of surgical procedures requiring general anesthesia and across all age groups. The LMA has become a critical piece of the American Society of Anesthesiologists' difficult airway algorithm. The ASA recommends LMAs when initial attempts at intubation have failed and mask ventilation is inadequate. There are limitations to LMA use, including: • procedures requiring muscle relaxation: • laparoscopic procedures, because abdominal insufflation pressures may limit the CLINICAL ADVICE Patient Selection Precautions atient selection is critical to the successful and safe use of laryngeal mask airways. Here are some instances when LMAs should be avoided, according to Rosalind Ritchie, MD, the medical director of the Center for Advanced Surgery and an assistant professor of anesthesiology at the University of Kentucky's Chandler Medical Center in Lexington. • Airway procedures. Is it a case where the surgeon needs to work in the airway or a case that will cause secretions such as blood or irrigation to accumulate? Remember, the LMA is not a protective airway. • Aspiration risks. Does the patient have risk factors for aspiration, such as morbid obesity, a hiatal hernia or gastroesophageal reflux disease? • Muscle paralysis. If muscle paralysis is crucial to optimizing the surgical procedure, the patient needs to be ventilated mechanically or by hand, which increases the risk of air distention in the stomach. — Daniel Cook P O C T O B E R 2013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E 7 3

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