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
