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LMA

Ian Seppelt SeppelI at wahs.nsw.gov.au
Wed Apr 19 23:46:57 BST 2006


But your original post indicated the need for "profound anaesthesia". I
refute that! 

Other people on this list have described the successful use of the LMA
pre hospital in conditions of much less than "profound anaesthesia". I
have seen it used successfully to relieve the airway in a hypoxic
agitated patient with massive facial injuries who as soon as he was
oxygenated woke up and quite happily breathed through the LMA until
arrangements could be made for a more definitive airway. My point was
merely that the device is relatively well tolerated - think of it as the
world's best oropharyngeal airway. I have a colleague who, as a "party
trick" can put a #4 LMA into himself without any anaesthetic and breathe
through it for an indefinite period of time [I won't comment on his
personal psychopathology but that's a different story!!!]

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

>>> eran at tal-or.co.il 19/04/2006 7:41pm >>>
Ian

Don't compare using LMA in the OR and the use of the LMA in the field.
The
paramedics don't use Propofol or other hypnotic drugs. The only drug
they
use is Ketamine (at list in our system). Second the pt are injured and
not
elective pt for operative procedure. So don't compare between apples
and
oranges.       

Eran Tal-Or M.D. M.H.A

www.airdoc.co.il 

 


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Ian Seppelt
Sent: Wednesday, April 19, 2006 9:43 AM
To: e_talor at rambam.health.gov.il; Trauma & Critical Care mailing
list
Subject: RE: LMA

Rubbish!! Quite lightly anaesthetised patients tolerate LMAs very
well.
Something I sometimes do for patients having total hip replacements
(slick surgeon, primary THR done in 40 minutes) is a spinal
anaesthetic,
TCI propofol to the lightest possible plane (because the lateral
position is quite uncomfortable) and if they start obstructing their
airway in this lateral position I put an LMA in because I am lazy. The
key to this is propofol, of course - this technique doesn't work as
well
with other agents.

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

>>> e_talor at rambam.health.gov.il 18/04/2006 5:36pm >>>
Just to remember that while using LMA the pt should be in profound
anesthesia. Any cough and the LMA are in the mouth and ventilation is
impossible. 

Eran Tal-Or M.D. M.H.A. 
Trauma Unit
Rambam Mediacl Center


|-----Original Message-----
|From: trauma-list-bounces at trauma.org [mailto:trauma-list-
|bounces at trauma.org] On Behalf Of Ian Seppelt
|Sent: Tuesday, April 18, 2006 4:05 AM
|To: trauma-list at trauma.org 
|Subject: Re: LMA
|
|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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