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LMA

Ian Seppelt SeppelI at wahs.nsw.gov.au
Tue Apr 18 03:05:00 BST 2006


I'm a few weeks behind.

I'm please to hear the LMA has caught on (it was only three years ago I
heard a VERY senior American anesthesiologist question what they place
they had in clinical anaesthesia)

In terms of sizes - a couple of LMAs is adequate to provide a rescue
airway for (almost) anybody you are going to intubate. If you are really
limited for space or weight the a #2 and #4 will work for most of the
population - not necessarily the best fit but enough to get a bit of
oxygen in.

For the disposable ILMAs, we have them in every ICU intubation trolley.
In terms of technique and function they are identical to the reusable
one. Considering we (hopefully) won't use them very often it is
difficult to justify the AU$900 per reusable ILMA, in a variety of
sizes, but at AU$50 it is hard to justify NOT having a full range of
sizes (in my adult ICU that is 3,4 and 5) in every intubation trolley.
We also have 3,4 and 5 classic LMAs as they are the most intuitive
rescue airways for those without much training. Various people have
argued for the Proseal LMA but I have rejected that on the grounds that
they are not as easy to insert unless you know what you are doing. I
used a disposable ILMA a few weeks ago for a woman with an unstable
odontoid fracture - worked like magic.

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> HAXScott at aol.com 7/04/2006 1:57am >>>
Ian, 
 
Use of laryngeal mask is routine in every state of this country and  in
most 
hospitals. We're behind in enough ways, and we shouldn't not  proclaim
our 
part in Dr. Brain's wealth... I'm sure it was American-demand  (read:
our fault) 
that the disposable LMA became so popular.
 
I appreciate and second your statement with regard to not being able to
 
contemplate not having the LMA available as a backup device for rescue 

ventilation - but I have to add my belief is that it should be wholly 
unacceptable to 
not have a rescue airway in sizes for the entire age and size  spectrum
in 
every environment: prehospital, ED, ICU, off-site response in 
hospital. 
 
Finally, I'd be curious to hear your assessment and experience with the
 
disposable version of the FasTrach LMA. It's not yet available here in
the US,  
however, we do use and I personally am quite fond of the reusable
version.  

Scott Hax
Lebanon, NH 
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