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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 73 of 118

OS_1310_part2_Layout 1 10/7/13 10:26 AM Page 74 A I R W A Y M A N A G E M E N T BACK TO BASICS Tips for LMA Success P ropofol is the best induction agent for laryngeal mask airway patients; it suppresses airway reflexes, and allows for insertion without the patient coughing or moving CLOSE WATCH Monitor reservoir unexpectedly. After insertion, test the airway's bags and capnogpatency using gentle hand ventilation, which should raphy waves to ensure airways remain patent. cause the patient's chest to rise without airway noise or audible air leak. The patient should complete unobstructed exhalation, with the anesthetic reservoir bag filling rapidly. The patient's oxygen saturation level should be stable and the capnography wave should be square in shape. A sloped capnography wave indicates an airway obstruction. A reservoir bag that fails to fill rapidly indicates a partial airway obstruction. A bag that fails to fill at all indicates a large anesthetic gas leak. If any of these occur, remove the LMA and try reinserting it again. Secure the LMA in place with tape so it doesn't move outward. When attaching the breathing circuit, ensure that it doesn't pull on the LMA enough to cause displacement. Ensure the anesthesia circuit's reservoir bag is always in plain sight and proper alarms on the anesthesia machine are activated to ensure this rare but potential issue is quickly detected. Disconnect the circuit when patients need to be repositioned mid-procedure. Reattach it when the repositioning is complete, and recheck the airway's patency. Insert a bite block — a roll of gauze between the lateral teeth works well — to help secure the device in place and prevent the patient from biting down during emergence. After surgery, keep the LMA in place until the patient emerges from anesthesia and can open and close her mouth on command. That's typically — Daniel Cook when protective airway reflexes have recovered. SOURCE: "The Laryngeal Mask Airway" in Update in Anaesthesia (tinyurl.com/ohs9oe4) 7 4 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 | O C T O B E R 2013

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