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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
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