Lesson 12

LMA Special Considerations

  • Contraindications:

    • Risk of gastric regurgitation and aspiration (e.g., full stomach, hiatal hernia, small bowel obstruction, symptomatic GERD).
    • Airway obstruction at or below the glottis.
    • Patient at risk of tracheal collapse (tracheomalacia or external compression).
    • Poor lung compliance.
    • High airway resistance.
    • Prone position: Not an absolute contraindication, but requires caution regarding replacement if dislodged.

  • In Special Scenarios:

    • "Can't intubate, can't ventilate" scenarios: LMA can be lifesaving even with aspiration risk.
    • In reactive airway disease, LMA is preferred over ETT unless contraindicated.

  • Gastric Regurgitation Risk Management:

    • Use LMA cautiously based on patient history and surgical position.
    • Maintain deep anesthesia to prevent swallowing and gastric insufflation.
    • Remove LMA at first sign of rejection.
    • Assess with epigastric auscultation and follow interventions if gastric content is present.

  • LMA vs. ETT in Asthma:

    • LMA reduces risk of bronchospasm during emergence, unlike ETT which may trigger cough reflex.

  • SNS Activation Comparison:

    • LMA is the least stimulating airway device compared to others (Combitube, DVL, Intubation).

  • Laparoscopic Procedures with LMA:

    • Use LMA ProSeal or Supreme for gastric drainage.
    • Avoid in obese patients and follow traditional NPO guidelines.
    • Maintain specified limits for tilt, intraabdominal pressure, and insufflation time.