Mask versus LMA

[cfdavid]

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I could do a lit search but....

Is there any difference in aspiration risk using a mask versus an LMA?

 

[cchoukal]

I would think there would have to be, but I doubt there's any literature on it. Despite what the oral boards examiners would have you believe, reflux and aspiration is a rare event (something like 1:1000 anesthetics; warner, warner, and weber did an interesting retrospective in the 90s that's worth a read), so it's hard to study.

Because the LMA tip sits in the introitus (love that word) of the esophagus, it may provide some protection (although it's equally plausible that such a position could stimulate reflux in a "light" patient).

I'm a ProSeal man, and once or twice I've seen refluxate creeping up through the esophageal port on that type of LMA. Frightening, certainly, but that channel seemed to be providing a diversion for the gastric contents which, if I had only been using a mask, would've instead gone into the lungs.

 

[cfdavid]

Thanks for the response. 👍

 

[jwk]

I did mask anesthetics for 15+ years before LMA's were even available. It's all about technique. I think a lot of people have become dependent on LMA's to the extent that they have really crappy technique with a mask, and probably would have a higher incidence of vomiting compared to LMA's because of their poor mask technique.

 

[cchoukal]

I did mask anesthetics for 15+ years before LMA's were even available. It's all about technique. I think a lot of people have become dependent on LMA's to the extent that they have really crappy technique with a mask, and probably would have a higher incidence of vomiting compared to LMA's because of their poor mask technique.

That's an interesting perspective. I have no doubt that we do fewer mask cases than in the past, but what, specifically, about your mask technique reduces the likelihood of reflux and aspiration?

 

[Idiopathic]

patient selection

 

[Hamhock]

Because the LMA tip sits in the introitus (love that word) of the esophagus,

I'm a ProSeal man,.

I don't know how to double "copy-respond" to posts, but the above quote makes me smile when the poster follows it with:

"I am a ProSeal man".

Nice.

It's like an advertisement.


HH

 

[beavis]

Because the LMA tip sits in the introitus (love that word) of the esophagus

Just the tip?

 

[cchoukal]

Just the tip?

I love that game...

 

[jwk]

That's an interesting perspective. I have no doubt that we do fewer mask cases than in the past, but what, specifically, about your mask technique reduces the likelihood of reflux and aspiration?

I think it's just practice, and not having options other than an ETT. Why get really good with a mask if you know you can pop in an LMA in 30 seconds anyway?

I think it's going to be a similar problem with intubations in the next few years. A lot of folks are using the GlideScope or similar devices for every intubation, or at least every intubation that looks the least bit difficult. I can easily see a generation of anesthesia providers that won't have the intubation skills we have now simply because they don't think they'll need them.

 

[deleted126335]

I did mask anesthetics for 15+ years before LMA's were even available. It's all about technique. I think a lot of people have become dependent on LMA's to the extent that they have really crappy technique with a mask, and probably would have a higher incidence of vomiting compared to LMA's because of their poor mask technique.

Agree with that part of your post. I Also think that mask anesthesia is a lost art that should not be rediscovered.