Till recently, I have been using endotracheal intubation for all general anaesthesia cases. These days it has been reported in literature much too frequently that LMAs are a safe and better alternative to tracheal intubations for most routine surgeries. This does not of course include the head and neck surgeries as well as obstetric ones. Previously a risk of aspiration of gastric contents into the lungs was considered as a disadvantage of LMA use. Due to this , many anaesthesiologists did not prefer their routine use instead of endotracheal tubes.
But now this trend is rapidly changing. Many international journals have reported that the use of LMA is safe in routine surgeries. This is especially true for the second generation LMA like PROSEAL and iGel .
I have now started the use of LMA for all my routine surgeries under general anaesthesia. This does not include the c-sections, for which I routinely use spinal anaesthesia. Even for Laparoscopic surgeries I am now using second generation LMA.
I have found that LMA are safe and easy to use. It has the advantage of easily decompressing the stomach by passing an drainage tube through the suction port of the second generation LMA. It is much easier for the patient to tolerate the LMA during maintenance of GA.
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| LMA Proseal |
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| iGel LMA #4 |
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| iGel LMA #5 |
I have faced two problems till now- firstly I found that the size of LMA which fits a particular patient is not always predicted accurately by the weight of the patient and secondly, though rarely, patients who develop laryngospasm are difficult to ventilate by LMA. The first problem seems to arise from the fact that some of the patients are underweight due to any reason and the LMA size needs to be adjusted accordingly. For the second problem, we need to avoid conditions leading to laryngospasm as far as possible.
As far as removal of LMA is concerned, as described in books ,I have found it to be much easier than extubation of a endotracheal tube, with significantly less rise in blood pressure and heart rate of patients.
