question about LMA contraindications

this is from a student perspective..... when told to use an lma in a patient who has absolute contraindications...how do you handle this? ......

could you be more specific as to absolute contraindications?

reflux? what?

deepz

well it's a diff situation as a student. i feel and have done this myself is to suggest what is the safest for the patient. if a pt is obese or has reflux etc. suggest ett for that specific reason. although i have had preceptors still want the lma and placed the pt on mech vent.

interestingly there is a research article in this months aana journal about lma and +pv. they seem to suggest it's ok in some instances. but not instances that are complete contraindications. so i'm sure none of this actually answered your question.

as a student make your case then move on, you are working under others licensure.

as a practicitioner you make the decisions that you feel most comfortable with, and that you can support with literature.

imho.

d

I have actually read the aana article. I believe they studied research comparing use of LMA's in patients who would normally have absolute contraindications. I think there were average pressures measured and these weren't high enough to cause regurgitation.

this is from a student perspective..... when told to use an lma in a patient who has absolute contraindications...how do you handle this? i have tried the..."isn't that a contraindication" but the point seems lost on most. i know that it is done often but...if something were to go wrong...it is very easy to find the "absolute contraindications" to use... any advice?

as another student...i think you have to look at it as a learning experience - learning what you won't do when you get out and practice on your own. some people are receptive to research articles or sections from anesthesia books to see what is being taught in schools today so they can learn as well if they are doing something that is contraindicated, but others it is lost on like you said.

i read the AANA journal as well - and would have to double check but was pretty sure that NONE of the patient had absolute contraindications: GERD, impaired GI motility, pulmonary dz, morbid obesity etc...

and i am pretty sure that it is the manufacturer that lists the contraindications...

i understand it is all a learning experience - it is just at times a very difficult position to be in as a student when you disagree with a treatment plan (in some way)...

i actually have used the LMA as the recent article in the AANA spoke about - we used smaller tidal volumes and kept our PIP

Two points:

1. As a student, sometimes (often?!?) your "anesthesia care plan" of the day is whatever the preceptor you are working with wants to do. Your day goes easier when the provider you are working with feels that you are flexible and agreeable. So, when I have a differing opinion from that of my preceptor, I approach the dicussion of the plan in terms of, "Now, some anesthetists would choose to do X, because of Y reasons, with Z rationale, in hopes of achieving Q outcome. What do you think about this?" Sometimes we change plans mid-stride, sometimes we continue with the provider's plan. That's fine. This seems to be received better than the, "well, I disagree. I think we should...". At least, it's working for me right now.

2. Keep in mind that the LMA is widely used in European countries and the Southern Hemisphere routinely and regularly in cases we wouldn't consider in the states. They put them in when patients are positioned prone, lateral, and sitting. They regularly put them on mechanical ventilation (keeping PIPs low, of course). They put them in when patients have mild reflux or are otherwise considered to be at an increased risk of increased residual volumes and reflux. The literature is full of studies conducted outside this country regarding these uses. So, the "absolute contraindications" you have in mind might not be so absolute after all. In the end, it's your comfort level and judgement of risk versus benefit that helps you make the right decision.