Download - Laryngeal Mask Lma
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Coni Senopadang
Hendy
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It is being increasingly used in place of a face mask ortracheal tubes during administration of an anesthetic,to facilitate ventilation.
Also used in patients with difficult intubation.
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THE CUFF
THE APERTURE BARS
THE AIRWAY TUBE
THE CONNECTOR THE INFLATION LINE
THE PILOT BALOON
THE VALVE
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An LMA consists of awide bore tube whose
proximal end connects toa breathing circuit andthe distal end is attachedto an elliptical cuff thatcan be inflated through apilot tube.
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Generally four types of LMAused these days:
Classic LMA
Flexible LMA
The proseal LMAwhichhas an orifice through
which naso -gastric tubecan be inserted
Fastrach LMAthatfacilitates intubatingpatients with difficultairways.
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Increase flexibility
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can separate between therespiratory andgastrointestinal tract
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Metal handle that servesto help insertion andintubation
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Verify that the size of the LMA iscorrect for the patient
Recommended Size guidelines: Size 1: under 5 kg
Size 1.5: 5 to 10 kg
Size 2: 10 to 20 kg
Size 2.5: 20 to 30 kg
Size 3: 30 kg to small adult Size 4: adult
Size 5: Large adult/poorseal with size 4
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No 1 : 2-4 ml No 2: Up to 10 ml
No 2.5: Up to 15 ml
No 3 : Up to 20 ml
No 4: Up to 30 ml
No 5 : Up to 30 ml
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Choose the appropriate size (Table 53) and check for
leaks before insertion.
The leading edge of the deflated cuff should bewrinkle-free and facing away from the aperture (Figure59A).
Lubricate only the back side of the cuff.
Ensure adequate anesthesia (regional nerve block or
general) before attempting insertion. Propofol withopioids provide superior conditions compared withthiopental.
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Place patient's head in sniffing position (Figure 59B
and Figure 516).
Use your index finger to guide the cuff along the hardpalate and down into the hypopharynx until anincreased resistance is felt (Figure 59C). Thelongitudinal black line should always be pointingdirectly cephalad (ie, facing the patient's upper lip).
Inflate with the correct amount of air (Table 5
3). Ensure adequate anesthetic depth during patient
positioning.
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Obstruction after insertion is usually due to a down-folded epiglottis or transient laryngospasm.
Avoid pharyngeal suction, cuff deflation, or laryngealmask removal until the patient is awake (eg, openingmouth on command).
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INTERNAL VIEW
OF PLACEMENT
OF LMA
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Failure to press thedeflated mask up
against the hard palateor inadequatelubrication or deflationcan cause the mask tip
to fold back on itself.
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Once the mask tip hasstarted to fold over, this
may progress, pushingthe epiglottis into itsdown-folded positioncausing mechanical
obstruction
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If the mask tip is deflatedforward it can push down the
epiglottis causing obstruction If the mask is inadequately
deflated it may either push down the epiglottis
penetrate the glottis.
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Situations involving a difficult mask (BVM) fit.
May be used as a back-up device whereendotracheal intubation is not successful.
May be used as a second-last-ditch airwaywhere a surgical airway is the only remainingoption.
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Pregnant (Greater than 14 to 16 weeks pregnant) Patients with multiple or massive injury
Massive thoracic injury Massive maxillofacial trauma Full stomach patient at risk of aspiration Pharyngeal pathology (e.g abscess). Pharyngeal obstruction .
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Although LMA is clearly not a substitue for trachealintubation but it has proven particularly helpful as a
temporizing measure in patients with difficult airwaysbecause of its easy of insertion and relatively high
success rate (95-99%).
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