LMA with GERD?

[soorg]

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What are people's thoughts on this?

I was trained to RSI everyone who is symptomatic, whereas an LMA is fine if there are no symptoms while on H2 antags/PPIs, or if it's only diet-related. Haven't heard about any official consensus statements from ASA about it either.

 

[2ndyear]

There will never likely be a consensus statement from the ASA, or anyone else on this one. I don't think you could accurately do a study to prove or disprove whether or not it is safe. I ask every patient about GERD, and it is almost rare to have someone that says, no never have GERD. Lots of people are on PPI's now with good control though. I have no problem placing LMA's in these folks. If they still have active symptoms that bother them that are not related to food, then ETT it is, most of the time. Lots of this is dogma. You can treat every single patient with GERD with IV zantac, reglan, po bicitra, cricoid pressure until their eyeballs pop out, and huge doses of sux. That's one way. The other is to realize risk vs benefit and stratify accordingly.

How about meds day of? If the patient is on an H2 or PPI, usually takes it in the morning, should we give them the dose if they forget to take it? I usually do, but this doesn't mean it's right. We're now more used to giving out beta blockers the morning of surgery (ONLY if they have already been on one at home, thank you POISE), so grabbing a Nexium or Prilosec is no big deal.

 

[periopdoc]

I usually intubate them with RSI. Place an NG tube, suction the stomach then lavage with a non-particulate antacid of choice. Remove the whole shebang and then place the LMA. Secure with 2 sticks of juicy fruit.

- pod

 

[dhb]

GERD is WAY OVERRATED where i'm at nobody cares about it and people don't aspirate on a daily base. If they have gastric content reflux to the pharynx when they lay down, tube them but that's a RARE condition.