Double Lumen LMA for Lap procedures?

[TraumaNurse]

Hey gang,

I went for a job interview last week and this place uses a double lumen LMA routinely for lap choles and other general lap cases. They even place them on a vent. with this LMA. I know places in Europe are using LMAs during mechanical ventilation, but I just don't feel it is worth the risk (especially with abdominal insufflation).

Are any of you using this type of LMA for Lap procedures?

This group was far too dictating of CRNA practice for my liking and I won't be going there to work, but I was just wondering what other people may be doing out there. I have not seen this type of LMA used anywhere else in this area.

[rn29306]

That was also what the mfg reps were touting also - the expanded roles of the double lumen LMA vs the 'regular' LMA.

Have not seen this in practice anywhere in TN or GA.

Anybody??

[jwk]

That was also what the mfg reps were touting also - the expanded roles of the double lumen LMA vs the 'regular' LMA.

Have not seen this in practice anywhere in TN or GA.

Anybody??

You're right, the sales reps push it, and the usual thing they say is "they do it in the UK".

There are two separate issues here - LMA's with vents, and LMA's with laparoscopies. LMA's with vents on pressure control (not volume controlled) doesn't bother me that much. My hand usually generates a pressure of 15-20cmH20 when bagging, so why would a vent at the same pressure be a big problem? I prefer to keep LMA patients breathing spontaneously anyway, so I don't use the vent much in actual practice.

LMA's with laparoscopies is entirely different. Besides insufflating the abdomen, many of these patients are in steep trendelenberg (particularly GYN scopes). To me, that's an absolute contraindication to an LMA. I know others do it, but it doesn't make good sense in my book.

The double lumen LMA doesn't impress me as particularly useful so far. However, the new fast-track model with built-in camera and self-contained LCD screen is way cool.

[athomas91]

i haven't seen these double lumen in particular - but i agree w/ your thinking - i know they use them for just about everything in the UK - but some of those things make me highly uncomfortable - and i don't know if lawsuits are quite as rampant in the uk as they are here -

i do dislike it greatly when "reps" try to make something "ok" that really isn't... anyway...

[snakebitten]

I have used the LMA Proseal for a Lap Chole. I inserted an NG tube through the lumen and held it to suction. Will I do it again, probable not. I just tried it on a thin women. No problems. But I did suck about 200cc's of bile out of her belly, which spooked me a little.

Mike