LMA in edentulous patients

[soorg]

Anybody know a good way to keep an LMA in place for an edentulous patient? They always seem to slide right out. Sarcastic answers not welcome!

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[rsgillmd]

Anybody know a good way to keep an LMA in place for an edentulous patient? They always seem to slide right out. Sarcastic answers not welcome!

Nothing fancy. Just a good tape job. One of my friends likes to fill any gaps with gauze.

If by "slide right out" you mean they come out totally, you may have the wrong size. I once put a 2.5 in an elderly gentleman. I really wanted to just stop wasting time and just put a tube, but my attending insisted on an LMA. So 4-->3-->2.5-->success.

 

[deleted126335]

Anybody know a good way to keep an LMA in place for an edentulous patient? They always seem to slide right out. Sarcastic answers not welcome!

leave the upper denture plate in.

 

[Noyac]

leave the upper denture plate in.

I agree but I will caution people b/4 doing this. I frequently let pts keep their dentures in during LMA cases. But last year one of my partners relieved me on one of these cases and I forgot to tell him about the dentures. I'm exactly sure what happened next but I know the dentures were found on the floor across the room as they were wheelin the pt to the PACU. Nobody saw them fly out of her mouth. Now I write on the tape "dentures in".

 

[coprolalia]

Try to use the LMA Supreme, if you have access to them. Overall, a much better fit, even in those with no teef.

-copro

 

[soorg]

Sounds good. How about maintaining spontaneous respirations while inducing for LMA placement? A lot of these older (usually cysto) patients come in with these huge, jowly faces, looking like they'd be a nightmare to mask ventilate. Any trick to keep them deep enough for an LMA insertion, while keeping them breathing, just in case the LMA doesn't seat well and they start to desat?

 

[Dirtball]

Glyco, no lube , #5 in everyone over 100lbs...#6 in everyone who can swallow it,

 

[Licoricestick]

gas induction. oxygen + sevo only till lma in. Then can titrate in small amounts narcotics. I do it about a once per month in exactly these types of patients.

Ditto - not sure how else you'd go about it, unless you wanted to topicalise and place it awake (not that i've ever seen anyone do that), but even then you'd still have to gas if you weren't confident you were going to be able to adequately IPPV throught the LMA.

Of course, if you're worried enough about ventilation and seating the LMA properly, it does beg the question of why you aren't using an ETT.

 

[Noyac]

Of course, if you're worried enough about ventilation and seating the LMA properly, it does beg the question of why you aren't using an ETT.

Not every person you are worried about these things in deserves an ETT.

 

[coprolalia]

If you suddenly have a problem with the LMA in the middle of the case, you can always intubate the patient then. Just tell the surgeon to stop operating for a second and do it. No big whup.

But, having said that, have never had a problem with the Supreme since I started using them. Have, at this point, literally put in hundreds of them (from residency to PP).

-copro