"Zippy" LMA insertion technique

[zippy2u]

The cat's meow is the "Zippy" LMA insertion technique... Partially inflate the lma so there are no ridges or indentations in the lma. Rub jelly on the part of the lma that will go in pt's mouth. Hold lma like pencil. Place lma in pt's mouth in a quick twisting fluid motion until resistance is felt. Done. If the placement takes you more than 3 secs you be candy a$$. No fingers should dig inside pt's mouth. You don't even need gloves on. You don't need to inflate lma once you place the lma in pt's mouth. Greenlings, learn this technique and you too shall enter "Zippydom" ---Zippy

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[Justin4563]

is that proseal or regular..

I do dig my index finger in the back of the oro pharynx. I inflate it just llike the zipster,,,, then i place the lma in the back of the mouthuntil it touches the finger then i slide it home.. I find the index finger assures that the tip does not bend in the oropharynx..

 

[zippy2u]

Your left hand is on pt's head placing them in the "sniffing position" which automatically opens their mouth. The right hand holds the lma towards the back like a pencil. No fingers should ever enter the mouth. The oropharyngeal soft tissue places pressure on the lma to provide an adequate seal so you don't have to inflate the lma after insertion.The partial pre-insertion inflation is all that is needed. The "zippy" method steps it up a notch compared to the "Archie Brain" method. This is for the regular LMA.

 

[Justin4563]

The proseal incidentally you cant do it like that.. the friggin handle is as flimsy as ever.. you need a stylet... its a much much better cuff than the regualr LMA however

 

[jetproppilot]

The proseal incidentally you cant do it like that.. the friggin handle is as flimsy as ever.. you need a stylet... its a much much better cuff than the regualr LMA however

don't like the proseals...too much work...I inflate as well, but I inflate it almost full, left hand on pts scalp, crank the head back, mouth opens, insert LMA into mouth, and now the proprietary JIGGLE technique...right hand holding the LMA tube, push posteriorly with morse-code motion, pops in every time. Use an LMA #4 always unless pt is King Kong (5) or Wee Man (3).
No gloves, no spit on hands, no problem.

Incidentally, the textbooks and the "experts" say not to inflate B4 insertion.

 

[zippy2u]

Another thing I see these greenlings do... Throw all the fookin' #5 LMAs out the window, they should only be used for anesthetizing horses and cows. #4s are for men and #3s are for women. I walk into the OR and cringe in a spastic motion when I see some CRNA cramming a #5 LMA into an obese woman cutting her lips all to hell and taking longer than 30 secs. Promise, within 3 secs with no trauma and no fingers in mouth and you will enter "Zippydom"

 

[coccygodynia]

Zippy - how about removal? I've been leaving it inflated on kids to get all the goobers out, and only deflating 1/3 on adults for the same reason. What's your preference?

- BTW, CRNA's aren't the only ones using #5's --> most of the partners in the group use 5's on any man over 110kg.

 

[zippy2u]

Jeez, people sometimes think the pt's mouth is a toilet bowl; they got rolled up 4 by 4 gauze shoved in the mouth, oral airways along with the LMA, Tongue depressors taped to 4 by 4 gauze, OGTs and the list goes on. Nothing else goes in mouth other than the LMA period. Deflate cuff and pull out LMA before pt has a chance to clamp down on LMA. ___zippy

 

[Justin4563]

Jeez, people sometimes think the pt's mouth is a toilet bowl; they got rolled up 4 by 4 gauze shoved in the mouth, oral airways along with the LMA, Tongue depressors taped to 4 by 4 gauze, OGTs and the list goes on. Nothing else goes in mouth other than the LMA period. Deflate cuff and pull out LMA before pt has a chance to clamp down on LMA. ___zippy

and how.. I agree.. just the LMA and thats it... take it out deep and inflated.

BUt i dont agree with you not advocating number 5 LMAs.. the BIGGER THE BETTER if you ask me. Just like double lumen tubes. pick the biggest one you can fit in.. that way it doesnt slide in and out of the left bronchus

How about endotracheal tubes I have seen people put in oral airways in.. I dont think t hat makes sense because the reflex when you have a ett is to open your mouth and gag not bite down.. SO the oral airway is for naught..

 

[militarymd]

I disagree about the sizes of airway devices. I know Benumoff (he's an egotistical ass, by the way) advocates big tubes and all, but from experience, and from learning from guys who have actually done it for 20 years (not like Benumoff who only talks about doing it) .....smaller the better when it comes to DLTs. I almost never use anything bigger than a 37 fr.

Same goes for ETT and lmas.....smaller the better....less sore throats, less vocal cord dysfunction...etc.

The only exception is when I intubate patients in the ICU....they need bigger tubes for pulmonary toilet issues....bronchoscopies, suctioning, t-piece trials...things like that.

 

[Justin4563]

I disagree about the sizes of airway devices. I know Benumoff (he's an egotistical ass, by the way) advocates big tubes and all, but from experience, and from learning from guys who have actually done it for 20 years (not like Benumoff who only talks about doing it) .....smaller the better when it comes to DLTs. I almost never use anything bigger than a 37 fr.

Same goes for ETT and lmas.....smaller the better....less sore throats, less vocal cord dysfunction...etc.

The only exception is when I intubate patients in the ICU....they need bigger tubes for pulmonary toilet issues....bronchoscopies, suctioning, t-piece trials...things like that.

benumoff gives one hell of a talk.. man he is good


bigger the better.. I do thoracic cases all the time.. when you turn them lateral the smaller tubes do come out of position much more frequently

ETT yeah ok smaller the better. for sure

Lma the bigger the better.. fits more snug.. less problems manhandling it

 

[jetproppilot]

I disagree about the sizes of airway devices. I know Benumoff (he's an egotistical ass, by the way) advocates big tubes and all, but from experience, and from learning from guys who have actually done it for 20 years (not like Benumoff who only talks about doing it) .....smaller the better when it comes to DLTs. I almost never use anything bigger than a 37 fr.

Same goes for ETT and lmas.....smaller the better....less sore throats, less vocal cord dysfunction...etc.

The only exception is when I intubate patients in the ICU....they need bigger tubes for pulmonary toilet issues....bronchoscopies, suctioning, t-piece trials...things like that.

I totally concur.

MILITARY IS A DONOR....ALL REGULARS NEED TO DONATE....GEEZ ITS PENNIES FOR THE TIME WE SPEND ON THIS FORUM....IF WE ALL DONATE MAYBE OUR EXPENSIVE COMPUTERS AND BROADBAND CONNECTIONS WILL TAKE US THROUGH THESE SDN PAGES LIKE THE SPEED OF LIGHT SOMEDAY, UNLIKE THE FLINTSTONE ROUTER OF CURRENT...

BTW, Chi, have you ever taken the front wheel of your rice-rocket off the pavement?

 

[jetproppilot]

and how.. I agree.. just the LMA and thats it... take it out deep and inflated.

BUt i dont agree with you not advocating number 5 LMAs.. the BIGGER THE BETTER if you ask me. Just like double lumen tubes. pick the biggest one you can fit in.. that way it doesnt slide in and out of the left bronchus

How about endotracheal tubes I have seen people put in oral airways in.. I dont think t hat makes sense because the reflex when you have a ett is to open your mouth and gag not bite down.. SO the oral airway is for naught..

As I said earlier, LMA #5s are for King Kong, and King Kong only.

 

[Justin4563]

how big is king kong

 

[jetproppilot]

how big is king kong

See dude, I always knew you were a cool kat...

 

[militarymd]

I totally concur.

MILITARY IS A DONOR....ALL REGULARS NEED TO DONATE....GEEZ ITS PENNIES FOR THE TIME WE SPEND ON THIS FORUM....IF WE ALL DONATE MAYBE OUR EXPENSIVE COMPUTERS AND BROADBAND CONNECTIONS WILL TAKE US THROUGH THESE SDN PAGES LIKE THE SPEED OF LIGHT SOMEDAY, UNLIKE THE FLINTSTONE ROUTER OF CURRENT...

BTW, Chi, have you ever taken the front wheel of your rice-rocket off the pavement?

I started practicing it 2 years ago. I can consistently launch in first, but I can't ride it through into 2nd. Not enough balls..

 

[zippy2u]

Militaryman is spot on. Think smaller when it comes to ETs, DLETs and LMAs. Yeah, I like that Left 37 French DLET for the men. The best ETs are made by Mallinckrodt period; stay away from "bobo" tubes like Sheridan. ---Zippy