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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