Anyone have any preferences one way or another?
For the record, I do it both ways
Usually awake. Some brands of LMAs have a rigid built-in bite block. If I'm not using one of those, I put in a soft bite block, ie roll of gauze wrapped with tape.
Keep working on your wake ups. Pts should not fight and/or bite when waking up. It is a rare occasion when I see this.I hate fighting biters.
I don't see the point of taking out an LMA just to replace it with an oral airway.Deep. Just about always. I usually pull it, slide in an oral airway, throw on a mask and roll to PACU. Usually by the time we hit PACU they're more awake and I take the oral out (or the patient does).
I don't see the point of taking out an LMA just to replace it with an oral airway.
A soft bite block solves the NPPE problem. I'll grant you there's no solving the PACU nurse problem. This job would be 43% easier without nurses around.2 reasons for replacing with oral airway - patients can't bite and occlude a guedel (I had a case of NPPE in a 16yo from this with an attending during residency who insisted on "awake extubations" with LMA's). also, all pacu nurses feel comfortable with oral airways, but not all pacu nurses feel comfortable with LMA's, and I want all pacu nurses to feel comfortable. my group works at 5 different sites and i am not interested in changing the culture/s.
there is no reason to pull LMA's awake or deep - i pull mine in between at 0.5-1.0 etsevo (or the equivalent with other anesthetics).
i do this because i want the pt deep enough not to bite the lma (and i place an oral airway) but light enough so that i don't have to support the airway for long if at all.
A soft bite block solves the NPPE problem. I'll grant you there's no solving the PACU nurse problem. This job would be 43% easier without nurses around.
I know you guys know this... but just for other readers out there that are learning the trade. NPPE can and does happen with LMAs with bite blocks in place. The obstruction in these cases is NOT due to the patient biting down on the LMA. It is due to laryngospasm and development of massive negative intrathoracic pressure against a closed glottis. Pink frothy pulmonary edema usually follows.
http://www.ncbi.nlm.nih.gov/pubmed/25669092
It can happen, however, with forceful biting on the LMA (never seen this).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401823/
I know you guys know this... but just for other readers out there that are learning the trade. NPPE can and does happen with LMAs with bite blocks in place. The obstruction in these cases is NOT due to the patient biting down on the LMA. It is due to laryngospasm and development of massive negative intrathoracic pressure against a closed glottis. Pink frothy pulmonary edema usually follows.
http://www.ncbi.nlm.nih.gov/pubmed/25669092
It can happen, however, with forceful biting on the LMA (never seen this).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401823/
I don't see the point of taking out an LMA just to replace it with an oral airway.
I pull some deep and some awake depending on the patient. For those of you pulling them deep, what is your definition of deep? That is the question.
No it's not.An LMA is an oral airway.
Deep is deep. Breathing spontaneously. No airway refelexes at all.For those of you pulling them deep, what is your definition of deep? That is the question.
Yes it isNo it's not.
No it's notDeep is deep. Breathing spontaneously. No airway refelexes at all.