WHAT DO YOU SUGGEST ?
Mike
mmackinnon at cox.net
Fri Sep 1 01:20:59 BST 2006
Hmm
I guess my prejudices then are that of both literature and the community. As
i said, LMAs ae not the backup airway device of choice. Airway experts agree
with this, evidence agrees with this why dont you?
ETT's have certianly proven to have less risk of aspiration than LMA. To
suggest otherwise flys in the face of every accepted and evidenced airway
course, book and expert.
All you did with your literature review was prove that it can be used. None
of these suggest less risk of aspiration (or equal) as with an ETT nor do
they suggest an LMA is the best choice.
m
----- Original Message -----
From: "Michael Shuster" <subs2subs at poky.ca>
To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Thursday, August 31, 2006 5:00 PM
Subject: RE: WHAT DO YOU SUGGEST ?
> You don't prove your point. Only your prejudices.
>
> No one said the LMA provides complete protection from aspiration. If you
> repeat your search inserting Combitube or endotracheal tube in place of
> LMA
> you will find cases of aspiration for these other devices as well. Cases
> are not evidence.
>
> For evidence see studies which test these devices for aspiration. They
> show
> no significant difference between the LMA and the ETT.
>
> Try:
> Ho, B. Y. M., H. J. Skinner, et al. (1998). "Gastro-oesophageal reflux
> during day case gynaecological laparoscopy under positive pressure
> ventilation: Laryngeal mask vs. tracheal intubation." Anaesthesia. 53(9):
> 921-924.,
> Maltby, J. R., M. T. Beriault, et al. (2003). "LMA-Classic and LMA-ProSeal
> are effective alternatives to endotracheal intubation for gynecologic
> laparoscopy." Can J Anaesth 50(1): 71-7.,
> Rewari, W. and H. L. Kaul (1999). "Regurgitation and aspiration during
> gynaecological laparoscopy: Comparison between laryngeal mask airway and
> tracheal intubation." Journal of Anaesthesiology Clinical Pharmacology.
> 15(1): 67-70.)
>
> Studies of LMA in resuscitation don't show any higher incidence of
> aspiration than do similar studies using Combitube or ETT.
>
> To list a few...
> Anonymous (1994). "The use of the laryngeal mask airway by nurses during
> cardiopulmonary resuscitation. Results of a multicentre trial."
> Anaesthesia.
> 49(1): 3-7.
> Kokkinis, K. (1994). "The use of the laryngeal mask airway in CPR."
> Resuscitation 27(1): 9-12.
> Stone, B. J., P. J. Chantler, et al. (1998). "The incidence of
> regurgitation
> during cardiopulmonary resuscitation: a comparison between the bag valve
> mask and laryngeal mask airway." Resuscitation 38(1): 3-6.
>
>
> -----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 5:20 PM
> To: Trauma & Critical Care mailing list
> Subject: Re: WHAT DO YOU SUGGEST ?
>
> 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 (LMAR) 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 & 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 & 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 & 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.
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/traumalist.html
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/traumalist.html
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/traumalist.html
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/traumalist.html
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
More information about the trauma-list
mailing list