WHAT DO YOU SUGGEST ?

Fri Sep 1 00:20:12 BST 2006

Oh my

I see your quick to make a statement without backing it up and i guess thats OK?

first, please do not compare the OR with the pre hospital arena, its like apples an oranges. When was the last time you drug someone out of a car, popped em on a backboard, tied em to it and then drove them anywhere? They are lying nice and prone on the OR table. NOT the same thing

Im not being dramatic, the Literature backs me up. Now, if you would like, i could post the other 50 orso articles which prove my point even in the OR. It is a common saying amoung anesthetists the LMA Let eM Aspirate. The reason why is to REMIND you that it does not stop aspiration. really, look at he design, that should be self evident. It rarely seats perfectly and the sizes are never perfect. Aspiration is a real issue with LMAs.

Here is my "nonesense". Next time, consider doing a medline search before you challenge someone.

M
      From the  British Journal of Anaesthesia 2004 93(4):579-582 

Aspiration and the laryngeal mask airway: three cases and a review of the literature 
C. Keller1, J. Brimacombe2,*, J. Bittersohl3, P. Lirk1 and A. von Goedecke1 
1 Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria. 2 James Cook University, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Australia. 3 Department of Anaesthesiology and Intensive Care Medicine, Philipps-University, Marburg, Germany 

* Corresponding author. E-mail: jbrimaco at bigpond.net.au

The primary limitation of the laryngeal mask airway (LMA®) is that it does not reliably protect the lungs from regurgitated stomach content. We describe three cases of aspiration associated with the LMA, including the first brain injury, the first death, and the first associated with the intubating LMA, and review the 20 specific case reports of aspiration associated with the LMA that we were able to find described in the literature. 

 O. Hung and J. A. Law
Advances in airway management
Can J Anesth, June 1, 2006; 53(6): 628 - 631. 

 R. S. Vaughan, I. T. Campbell, S. Patel, G. Turner, J. Brimacombe, and C. Keller
Aspiration and the laryngeal mask airway
Br. J. Anaesth., April 1, 2005; 94(4): 545 - 547. 

Cook C, Gande AR. Aspiration and death associated with the use of the laryngeal mask airway.
Br J Anaesth. 2005 Sep;95(3):425-6

 Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature.
J Clin Anesth. 1995 Jun;7(4):297-305. 

Ismail-Zade IA, Vanner RG. Regurgitation and aspiration of gastric contents in a child during general anaesthesia using the laryngeal mask airway.
Paediatr Anaesth. 1996;6(4):325-8

Campbell IT.  Aspiration and the laryngeal mask airway.
Br J Anaesth. 2005 Apr;94(4):545-6

Cassinello F, Rodrigo FJ, Munoz-Alameda L, Perez-Tejerizo G, Vallejo D.  Postoperative pulmonary aspiration of gastric contents in an infant after general anesthesia with laryngeal mask airway (LMA)
Anesth Analg. 2000 Jun;90(6):1457.

Griffin RM, Hatcher IS.  Aspiration pneumonia and the laryngeal mask airway.
Anaesthesia. 1990 Dec;45(12):1039-40. 

.----- Original Message ----- 

From: "Michael Shuster" <subs2subs at poky.ca>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Thursday, August 31, 2006 3:58 PM
Subject: RE: WHAT DO YOU SUGGEST ?

> What nonsense.  
> 
> There's absolutely no evidence that there's any difference in rate of
> aspiration between LMA, Combitube or endotracheal tube.  Studies have been
> done with each of these devices in the OR using methylene blue.  All
> performed well (but not perfectly).  Studies of each of these devices in
> resuscitation have not shown any differences in rates of aspiration.
> 
> Michael
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Mike
> Sent: Thursday, August 31, 2006 4:44 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: WHAT DO YOU SUGGEST ?
> 
> you know what LMA stands for?
> 
> Let eM Aspirate.
> 
> LMAs have no place in EMS.  ILMAs are the best choice or even a combitube
> will protect against aspiration better than an LMA.
> 
> m
> ----- Original Message -----
> From: "MARK FORREST" <atacc.doc at btinternet.com>
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Thursday, August 31, 2006 3:06 PM
> Subject: Re: WHAT DO YOU SUGGEST ?
> 
> 
>> LMA......simple, quick, reliable and easy to convert to 
>> intubation/definitive airway as soon as possible...why struggle!
>> Mark F
>> Anaes/Crit Care Cons,UK
>>
>>
>> ----- Original Message ----
>> From: ofiara at comcast.net
>> To: trauma-list at trauma.org
>> Sent: Thursday, 31 August, 2006 10:03:42 PM
>> Subject: WHAT DO YOU SUGGEST ?
>>
>>
>>>From an EMS standpoint, with the various pt.population,(old to young). 
>>>Reasons for an advanced airway:(trauma-medical-burns), and the places you 
>>>may be intubating,( the box, a darkly lighted small room in a house-on 
>>>scene of a MVC), what do you suggust as a back-up to the ETT. A 
>>>Combi-tube, a LMA or a bougie ? Thanks  for any input.
>>  Larry Ofiara, R.N.
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