LMA's on the vent

Started by 2ndyear
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2ndyear

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Has anyone put a patient with an LMA on the vent? I was thinking about this today as a patient took a lot of propofol and apparently too much fentanyl on induction, and I was left squeezing the bag for quite some time. We don't have the new ProSeal LMA's which are apparently designed for this, just the regular classic model. My rationale is that I had a vent that would do pressure control, had an LMA that didn't leak until 20 and could set my vent less than this. Whether I would have had adequate tidal volumes at this pressure would be irrelevant as there was no ventilation above 20, limited by myself on the bag.
 
2ndyear said:
Has anyone put a patient with an LMA on the vent? I was thinking about this today as a patient took a lot of propofol and apparently too much fentanyl on induction, and I was left squeezing the bag for quite some time. We don't have the new ProSeal LMA's which are apparently designed for this, just the regular classic model. My rationale is that I had a vent that would do pressure control, had an LMA that didn't leak until 20 and could set my vent less than this. Whether I would have had adequate tidal volumes at this pressure would be irrelevant as there was no ventilation above 20, limited by myself on the bag.
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I have. I have done the same thing (a little too generous on the propofol and fentanyl) and was left bagging for quite a while. Hard to chart and do everything else when you have to squeeze the bag. I ended up putting them on the vent, pressure control, PIP 18, rate 14. Patient did fine...took about 15 minutes to get them breathing again. It was a cysto, so it was fairly quick - just when he started breathing again, they were done. This was with a regular LMA classic.
 
I do it all the time as well. If you are delivering an adequate tidal volume via a ventilator vs. your hand it's a six of one half-dozen of another scenario.
 
not a big deal. even if you get above 20cm H20 (just shouldn't get much above 25-30). i think the whole "air in the stomach" thing is overblown. haven't seen the proseal used much (too $$$). i even had an attending relax a patient with an LMA yesterday. i couldn't believe it at first. but, case went fine.
 
VolatileAgent said:
i even had an attending relax a patient with an LMA yesterday. i couldn't believe it at first. but, case went fine.
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I did it today. The 2cm umb/inc hernia became a bigger deal than expected and omentum was all over the place. Surgeon needed to be able to keep the omentum in while sewing in the mesh. Pt was a bigtime asthmatic, wheezing b/4 surgery (baseline), and I didn't want to intubate if I didn't need to. It worked fine.
 
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