Modified technique in securing the LMA in multiple extractions

Abstract

Aims: We have developed a technique to secure the LMA without obstructing the surgical field and have minimal interference with airway maintenance. Nasal endo‐tracheal tube is the gold standard for airway maintenance; however, it can slow turnover time due to it requiring a longer recovery time compared with the laryngeal mask airway (LMA). The LMA position often obscures the surgical field in these cases often necessitating repositioning intra‐operatively. This can adversely affect airway patency. Materials and methods: We audited two different techniques of securing LMAs (north‐facing with our modification vs. south‐facing conventional taped to the lower lip/chin) in a total of 223 patients undergoing bilateral extractions. A questionnaire for surgeons and anaesthetists was used to assess their suitability and complications occurred noting particularly obstructions caused to the LMA, cause for obstruction, management taken to correct obstruction. Results: We found the risk of partial or total obstruction of the airway during surgical extractions with a conventionally placed LMA to be around 36% compared with 19% with a retromolar positioned flexi‐LMA during our study. Conclusion: The retro‐molar positioned LMA not only increased operating space but showed a reduced number of obstructions caused to the LMA.

A novel technique for securing supra-glottic airway device to prevent mal-positioning

“…Displacement of a supra-glottic device after its perfect placement is quite common and poses a challenge to anaesthesiologist. [ 5 ] Repositioning the supra-glottic device in the middle of the surgery can be quite difficult which is preventable by proper securement. Only adhesive tape at lips or jaw may not be adequate to prevent displacement, especially rotational mal-positioning by unanticipated traction force during patient positioning or transport.…”