Re-using LMAs and ETT

[samtron]

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I recently had the opportunity to observe Anesthesia in a developing country. Overall I think the level of intra operative anesthesia was pretty good given the ridiculous financial constraints that they are faced with. The level of knowledge by the attending was very good.

I and was shocked and saddened, however, that they re use LMAs and ET tubes (1 tube per size per OR). Since they supposedly degrade with sterilization they simply wash them with soap and water between patients.

Does anyone know if sterilizable LMA or ET tubes exist?

FYI:

Post OP Pain control is a shot of diclofenac in the thigh.

PONV controlled by rolling patient in lateral position.

Post OP monitoring consists of wheeling the patient to a dark, hot room and calling the family member to come and watch their nail beds to make sure they don't turn blue. This is minutes after extubation without O2, nurses or monitors.

On a positive note, this all done at no charge to the patient 😉

 

[urge]

Do they sterilize silverware at restaurants? I have LMA, tubes, and laryngoscopes in the same category.

Don't they re use syringes in rich countries like the USA?

 

[ChrisA]

This is very common on missions.

Use a pipe cleaner and cidex hang up tube overnight and it is ready for the next patient.

Scary, i know but otherwise these people would have nothing.

BTW, kudos to you for going on a mission. More people should.

 

[jwk]

I recently had the opportunity to observe Anesthesia in a developing country. Overall I think the level of intra operative anesthesia was pretty good given the ridiculous financial constraints that they are faced with. The level of knowledge by the attending was very good.

I and was shocked and saddened, however, that they re use LMAs and ET tubes (1 tube per size per OR). Since they supposedly degrade with sterilization they simply wash them with soap and water between patients.

Does anyone know if sterilizable LMA or ET tubes exist?

FYI:

Post OP Pain control is a shot of diclofenac in the thigh.

PONV controlled by rolling patient in lateral position.

Post OP monitoring consists of wheeling the patient to a dark, hot room and calling the family member to come and watch their nail beds to make sure they don't turn blue. This is minutes after extubation without O2, nurses or monitors.

On a positive note, this all done at no charge to the patient 😉

Re-usable LMA's are still on the market and in use in the US.

Going on mission trips is an eye opener - it's like going back 40 years or more. One of my docs made it interesting and challenging for himself - he took two bottles of isoflurane on an India trip, and made it last two weeks by doing a closed circuit/liquid inject technique on most of his general anesthetics. Lots of these places won't have pulse oximetry, much less gas monitoring. It can be done - and it's how it was done when I first started in anesthesia.

 

[Bertelman]

I've seen them reuse sterile gloves. And yes, we still reuse LMAs in the U.S., although it is typically after autoclave.

30 yrs ago we were reusing ETTs.

 

[samtron]

I appreciate the silverware argument, however, I doubt anyone would be excited about a used LMA/ETT for their family member.

The local attending told me about an instance where a used LMA was so brittle that it fractured intra op into several pieces. Luckily they were able to fish most of them out with their fingers and carry on with the operation.

I do think US healthcare has gone over the top with the use of disposable medical supplies.

 

[coprolalia]

I appreciate the silverware argument, however, I doubt anyone would be excited about a used LMA/ETT for their family member.

The local attending told me about an instance where a used LMA was so brittle that it fractured intra op into several pieces. Luckily they were able to fish most of them out with their fingers and carry on with the operation.

I do think US healthcare has gone over the top with the use of disposable medical supplies.

Nah, we need to give kids visiting New Jersey beaches interesting things to play with.

-copro

 

[2ndyear]

We have reuable LMA's of the proseal variety and use them every day. Haven't looked much into the cost of the disposable model.