We use controlled breathing with LMA quite often. Some of my patients complain of stomachache following the surgery. Although appropriate sealing is achieved, it occurs to me that it could be due to air insufflation through LMA. What do you think? Any similar experiences?
We use controlled breathing with LMA all most times but our patients didn´t complain. We used pressure controlled breathing.
Dear Anthony,
Thank you for your thorough explanations.
Unfortunately, most of the devices we are using in the OR do not have the PSV mode option. Administration of anesthesia depth control devices like BIS etc. also is not routine in our centers. That is to say, most centers do not have access to these devices. The scenario which I explained mostly happens in our ophthalmic surgery cases which we need to perform muscle-relaxation for the patients; yet, the surgeries do not last long (approx 15-20 mins).
Thank you dear Natasa. In our centers, we have to anesthetize so many patients in a limited time. In the ophthalmology surgery section, I have to use LMA in order to have quick emergence. Naturally, loco-regional anesthesia is not applicable. Also, our ventilators are not so good to count on. I guess we have to get along with it!
Some LMA´s have a suction channel emerging through the tip for emptying the stomach. But proper insertion technique and adequate anesthetic depth should prevent gas insufflation. Not a problem in our dpt., 3000 LMAs/yr.
Thank you dear Sven. Actually we do not use Supreme LMA. The LMAcs which we use are not disposable ones. In fact, due to limited resources we overuse them. I suppose this would be a part of the puzzle. We do not consider the manufacturer recommendations regarding the number of the times each LMA can be used. We have no other choice.
Economic constraints affect our practice. In my younger days, we also re-used disposable ETT´s in Denmark!
I find that the Ambu LMA´s provide a good fit.
Parameters within your control: ventilator settings and anaesthetic depth.
Thank you dear Sven. Working in resource-limited settings has its own advantages. You learn how to stick to basic material and resources. Thank you for the advice.
Who is not recommending? It is no problem at all, provided that the patient has an empty stomach. There is no need to struggle with an ETT for the sole purpose of controlled ventilation, when you can just as easily insert an LMA.
A properly inserted LMA sustains a 20cm H2O pressure gradient, sufficient for most patients. We routinely use LMA´s for malignantly obese (BMI>50) patients in ramp postition.
http://www.ncbi.nlm.nih.gov/pubmed/24353586
http://www.ncbi.nlm.nih.gov/pubmed/24348297
I’m old timer trained in the US when LMA was just introduced for wide use. I dint understand why to use PPV at all with LMA when spontaneous respiration is such great indicator of depth of anesthetic, when I can use it to dose narcotic etc. As of safety- if there’s absolutely no stimach inflation ever with PPV via LMA why don’t we abandon ETT for average non full stomach patients?im convinced it’s wrong to do PPV with LMA- sane as speeding: you get away 98% of the time but 2% will be bad bad outcome. Hit me now.
We do most of our general anesthetics with LMA's and pressure control ventilation. If one makes sure that the LMA tip is not flexed dorsally (something that happens very often with our Ambu models), patient complaints are rare, < 1%.
I find it strange that statements about airway practise are being put forward without any reference to data or arguments.
Most modern anaesthetic machines monitor breathing circuit leak. If this is 0, it means that no inspired air enters the stomach.
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