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Fri Sep 1 01:49:00 BST 2006

The articles cited seem to refer to fasted elective patients

David Fontana RN

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of MARK FORREST
Sent: Friday, 1 September 2006 10:34
To: Trauma &amp; Critical Care mailing list
Subject: Re: WHAT DO YOU SUGGEST ?

Sorry, mike, but still not buying the fact that ILMA offers better
protection then LMA. If you really want the best supraglottic protection
then you should be considering the 'Proseal' as used by HEMS London and
others, or alternatively the AMD which both provide some theoretical
reduction in stomach inflation, regurg and potentially aspiration.

As for the ILMA being as simple to use as a conventional
LMA.........well all I would suggest is that every anaesthetist in our
department uses the LMA several times every day, they use the ILMA on
the odd training case and occasionally in the ER....which is likely to
have the greatest success in an emergency, especially for those who have
never seen the ILMA before? 

In addition, I have always  found the process of intubation through the
ILMA pretty simple yet more fiddly than a bougie through the LMA (blind
or with  a scope). In view of this we have abandoned the ILMA in our
hospital and on the Pre-hospital team. Nice to have in the box and still
demonstrated as an option on our courses, but over-rated by it's fans in
real practice.

Finally, what is the cost of the ILMA compared to the LMA?! 

Regards

Mark F
UK

----- Original Message ----
From: Mike <mmackinnon at cox.net>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Friday, 1 September, 2006 12:50:10 AM
Subject: Re: WHAT DO YOU SUGGEST ?

hey

Im not saying the LMA is bad. Im saying its not as good as the ILMA. As
the 
question was "what is the best" the answer is ILMA.

with all due respect, anecdotes are NOT evidence.

As for my literature search, i included all the cases i found in regards
to 
aspiration risk and the LMA. Millers anesthesia as well as Rosens
Emergency 
medicine and Ron Walls book INCLUDING every airway class taught in the 
country (i teach a few of them) clearly, and i do mean clearly, state
the 
LMA is a choice of last resort and an ILMA is superior. The research
also 
backs this up.

The fact is the evidence isnt conflicting. The perpondeance of evidence 
suggests one thing, an LMA (or any superglottic device) is only better
than 
Masking a patient. All of these devices risk aspiration. The ILMA does
not 
when used properly by passing an ETT.

I agree with you that an LMA is absolutely better than nothing, but it
is 
not the "best option" which is what the poster had asked for.

m
----- Original Message ----- 
From: <HAXScott at aol.com>
To: <trauma-list at trauma.org>
Sent: Thursday, August 31, 2006 4:35 PM
Subject: Re: WHAT DO YOU SUGGEST ?

> Further, a quick review of the literature would yield uncommon but 
> very
> real
> problems associated with the Combitube, including multiple cases of
> esophageal rupture. I can share multiple anecdotes of the LMA being
used 
> successfully
> as a rescue airway after failed intubation. In the past year at  least
two
> adult patient have arrived in our TRU after failed intubation by other
> hospitals and were successfully ventilated and oxygenated without 
> substantial
> aspiration.
>
> In my own experience, Combitubes are used quite commonly by our ground

> EMS teams, and as a primary airway by some EMT-B and EMT-I level 
> providers, and we covert a number of Combitube placements to tracheal 
> tube. Conversion to ETT
> is  much easier with the LMA than with the Combitube. I have had
success
> (though the  rate in the literature is low, about 50%) with converting
LMA 
> to ETT
> simply by  intubating the trachea with a bougie via the LMA and
advancing 
> an ETT
> over the  bougie once the LMA was removed... and what of our children?

> There
> is no  pediatric version of the Combitube. The LMA has been used 
> world-over as
> a rescue  device for pediatric failed airway, including children with 
> major
> craniofacial  anomalies.
>
> Mr. MacKinnon, I'm glad to see you can conduct a literature search and

> include only those reviews, that which support your belief. The truth 
> and reality, back down here with the rest of us, about the LMA and 
> it's use as a rescue
> airway, is that it's NOT nearly as bad of a device as you would paint
it, 
> and
> that the risk of aspiration, is greatly exaggerated by detractors of
the
> device such as yourself.
>
> I'm truly very sorry to inform you, that the LMA has proven it's 
> utility
> as
> a rescue device in hospitals and in the field the world over. While
> admittably,  the available evidence may be conflicting, we are at the
very 
> least assured
> that  aspiration with the LMA is rare, as proven by large trials in 
> important
> and  unbiased efforts by a number of investigators, and there is 
> absolutely
> no  question that it's proven itself.
>
> My hat is off to Archie Brain.
>
>
>
>
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