-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
What should I do if the laryngeal mask leaks? In clinical work, I believe that everyone will encounter the difficult situation of laryngeal mask leaka.
I hope this article can help you~ The inventor of the master teaching laryngeal mask, .
Archie Brain from the United Kingdom, in his article published in BJA Magazine in 1983 (The laryngeal mask – A new concept in airway management, BJA 1983;55 :801) described the application of his self-made laryngeal mask in his first group of 23 patients, in which the description of the air leakage treatment can give us a good reference, and can also tell us that the air leakage of the laryngeal mask is not a problem from the beginni.
A technical problem affecting the use of the laryngeal mask can be solved as simply as the problem can be eliminated by inflating the balloon when a tracheal tube is often leak.
Table 1 Instances in which leaks developed at the laryngeal mask -larynx interface Change mask position) 1Reduce cuff volume (reduce cuff inflation) 1Increase cuff volume (increase cuff inflation) 1Change to wider mask prototype (choose a laryngeal mask with a wider mask) 1Change to larger mask prototype (choose a larger mask prototype) Laryngeal mask with large sack) 1Leak stopped spontaneously (the leak stopped after spontaneous breathing) The 23 cases above by .
Brain were all successf.
According to the report in the article, all the air leaks occurred in the first 6 cases of its use, all occurred after insertion and all resolved before the start of the operation without much difficul.
(Original text: Leaks were present initially in six patients, but were successfully abolished in a.
Of the leaks which developed all occurred after insertion but before surgery was started and all were overcome with little difficul.
) Considerations Problem Solving—although SGA usually Placement can be successful, but insertion and ventilation-related problems can still occ.
Insufficient anaesthesia – The initial difficulty in placing the SGA may be due to insufficient anaesthesia, in which the patient experiences force, breath hold, or high upper airway tension that prevents proper device placeme.
Insufficient depth of anesthesia may also cause laryngospasm or bronchospasm, which can cause airway obstructi.
If clinically appropriate, ventilation can be improved by the administration of additional anesthetics (eg, propofol or inhalation anesthetics) without the need for further SGA procedur.
●Deflexion of the epiglottis – When placing the SGA, the tip of the epiglottis may fold over, causing variable ventilation or airway obstructi.
This situation can be corrected by deploying the epiglottis with the "up-down maneuver" [11], in which the SGA is retracted 2-4 cm and reinserted without expelling the air from the cu.
Ineffective ventilation may also be improved by patient head extension, slight advancement or retraction of the SGA, and removal and repositioning of the S.
● Inadequate sealing – Improper unit size may be difficult or impossible to achie.
In general, larger models achieve better seals with lower cuff inflation volumes or inflation pressures than smaller SGA models [5-7]
The solution to an insufficient seal may be to insert a larger SGA rather than inflate the cuff with more a.
A retrospective study of approximately 19,700 anesthetized patients involving the use of SGA showed an increased rate of SGA insertion failure with size 2 and 3 SGA [1
(See 'Selection of size' above) ● Patient anatomy – The patient's anatomy may make placement of the SGA difficu.
If placement difficulties exist, placement of a partially inflated LMA using rotational techniques [13] or placement with the aid of a fiberoptic laryngoscope or ultrasound [14] may be helpf.
Treatment Methods Improper positioning can sometimes be managed by repositioning the patient's head, repositioning the SGA, or adjusting the amount of air in the cu.
If in doubt, we recommend reinserting the SGA from scratch, or sometimes switching to endotracheal intubati.
Choice of ventilation mode — SGA can be used in both spontaneously breathing patients or in patients with P.
Because the SGA does not seal the pharynx, leaks around the device limit the pressure that can be safely used for ventilation, and leaks around the device can cause gastric inflation and/or hypoventilati.
Therefore, when the SGA is in the correct position, pressure-limited ventilation [ie, pressure support ventilation (PSV) or pressure-controlled ventilation (PCV)], rather than volume-controlled ventilation, is usually us.
The use of LMA during spontaneous breathing has several advantages: • The opioid dose can be gradually adjusted according to the patient's breathing ra.
● Rarely can cause gastroesophageal inflation proble.
●The possibility of air leakage around the SGA is less than when using P.
●Patients tolerate a certain degree of SGA misplacement bett.
On the other hand, the use of SGA devices for PPV has the following advantages: • PPV allows control of respiratory rate, tidal volume and minute ventilati.
●Hypoventilation can be avoided during deep anesthesia and when high doses of opioids are giv.
Many researchers have explored the application of the PPV+SGA devi.
Most LMAs and most other SGAs are designed for use at peak pressures below 20 cmH2O, and many studies have shown that leaks and gastric inflation occur minimally if peak pressures are maintained at 15-20 cmH
The LMA ProSeal is designed to allow use at higher ventilation pressures, and its cuff contains a posterior extension to achieve a "double seal" that allows peak airway pressures up to 25cmH2O without leaki.
Pressure-controlled ventilation — PCV is a mode of PPV commonly used in S.
With PCV, respiratory rate, peak inspiratory pressure, and other parameters can be s.
In contrast to volume-controlled ventilation, PCV prevents peak pressures that can lead to airway leaks and gastric inflati.
When the LMA is properly placed, the peak pressure is set at 15-20 cmH2O, and the respiratory rate is adjusted to achieve adequate minute ventilati.
Pressure support ventilation — We routinely use PSV when using SGA, but not all anesthesia ventilators support PSV mo.
In PSV mode, the patient initiates each breath and the ventilator provides additional support based on preset pressure valu.
A minimum number of breaths needs to be s.
In this mode, the patient controls their own respiratory rate and tidal volume, but if the resulting minute ventilation is too low, the minimum respiratory rate or level of pressure support can be increas.
A randomized crossover study comparing PSV with continuous positive airway pressure (CPAP) when using LMA showed that the CPAP setting was higher than end-expiratory ventilation when compared with spontaneous ventilation when CPAP was set at 5 cmH
The PSV gas exchange was more efficient when the positive end-expiratory pressure (PEEP) was 5 cmH
Use of neuromuscular blocking agents — To help prevent gagging, coughing, and laryngospasm, neuromuscular blocking agents (NMBAs) may be given to aid placement of the SGA, especially in certain situations (eg, thiopental sodium) for anesthesia inductio.
In addition, NMBA can be given to facilitate endotracheal intubation through the L.
A study evaluating the effect of NMBA administration during intubation of a cannulated LMA showed that the use of NMBA reduced patient coughing and movement during intubation and decreased the difficulty of removing the L.
NMBA may be helpful for PPV using SGA or to reduce the likelihood of laryngospasm during airway irritating procedures (eg, flexible bronchoscop.
NMBA is also used when the surgeon requires relaxation of the muscles to improve surgical exposu.
Misalignment clearly tells you that there are several possible misalignments of the LMA, as shown in Table Adjustments to the LMA Improperly positioned LMA may present with difficult ventilation (no respiratory movement or low tidal volume with high pressure) or low inspiratory pressure or large air leaks
In general, blindly (ie, no FOB), moving the LMA, or rotating are unlikely to correct the misalignment (see Table
A consequence of this is that accurate diagnosis of dislocation can only be done with the help of F.
How to Correct a Clearly Written LMA Correcting a mispositioned LMA should start with removing the mask completely before reinserting it:Make sure your LMA is the correct size, use weight-based guidelines, and refer to your own Preoperative airway examination and clinical judgme.
Inspect the LMA for damage and verify that the cuff is not leaking during inflati.
Depending on the type of LMA, you may want to form the hood into a smooth, flat wedge sha.
Lubricate the rear surface of the ma.
With the patient in the "sniffing flower" position, lift the neck and extend the head (see Figure
This position best aligns the oropharyngeal, laryngeal, and tracheal ax.
In larger patients, it is critical that the "inclined position" raises the ear canal above the level of the stern.
Adequately anaesthetize the patient - Insufficient anaesthesia, a taut state of the jaw will make placement of the LMA difficult or impossib.
Holding the LMA in a pen->
Slide the LMA along the hard palate, pushing it into the upper jaw as it advances down the phary.
Using your index finger as a guide for the tip of the LMA can help prevent the tip from collapsing and help push the tongue aw.
If the tip of the LMA is close to the posterior pharynx and not towards the vocal cords, place the index finger of the non-dominant hand behind the tip of the hypopharyngeal LMA so that the laryngeal mask tip is flexed forward, towards the vocal cords (in a "kick-and-shoot" motio.
; see Figure 5)Gently advance until resistance is encounter.
1 Inflate the cuff with the appropriate amount of a.
1 Verify proper placement with etco2 and auscultati.
OK did you learn? Welcome to leave a message to discuss your good method~ The previous link is the experience of Xiaowu school laryngeal mask (1) The status and history of Xiaowu school laryngeal mask experience (2) Those who have a high value and a variety of laryngeal masks~ Xiao Experience of Laryngeal Mask in Martial Arts Correct insertion method of the mask
I hope this article can help you~ The inventor of the master teaching laryngeal mask, .
Archie Brain from the United Kingdom, in his article published in BJA Magazine in 1983 (The laryngeal mask – A new concept in airway management, BJA 1983;55 :801) described the application of his self-made laryngeal mask in his first group of 23 patients, in which the description of the air leakage treatment can give us a good reference, and can also tell us that the air leakage of the laryngeal mask is not a problem from the beginni.
A technical problem affecting the use of the laryngeal mask can be solved as simply as the problem can be eliminated by inflating the balloon when a tracheal tube is often leak.
Table 1 Instances in which leaks developed at the laryngeal mask -larynx interface Change mask position) 1Reduce cuff volume (reduce cuff inflation) 1Increase cuff volume (increase cuff inflation) 1Change to wider mask prototype (choose a laryngeal mask with a wider mask) 1Change to larger mask prototype (choose a larger mask prototype) Laryngeal mask with large sack) 1Leak stopped spontaneously (the leak stopped after spontaneous breathing) The 23 cases above by .
Brain were all successf.
According to the report in the article, all the air leaks occurred in the first 6 cases of its use, all occurred after insertion and all resolved before the start of the operation without much difficul.
(Original text: Leaks were present initially in six patients, but were successfully abolished in a.
Of the leaks which developed all occurred after insertion but before surgery was started and all were overcome with little difficul.
) Considerations Problem Solving—although SGA usually Placement can be successful, but insertion and ventilation-related problems can still occ.
Insufficient anaesthesia – The initial difficulty in placing the SGA may be due to insufficient anaesthesia, in which the patient experiences force, breath hold, or high upper airway tension that prevents proper device placeme.
Insufficient depth of anesthesia may also cause laryngospasm or bronchospasm, which can cause airway obstructi.
If clinically appropriate, ventilation can be improved by the administration of additional anesthetics (eg, propofol or inhalation anesthetics) without the need for further SGA procedur.
●Deflexion of the epiglottis – When placing the SGA, the tip of the epiglottis may fold over, causing variable ventilation or airway obstructi.
This situation can be corrected by deploying the epiglottis with the "up-down maneuver" [11], in which the SGA is retracted 2-4 cm and reinserted without expelling the air from the cu.
Ineffective ventilation may also be improved by patient head extension, slight advancement or retraction of the SGA, and removal and repositioning of the S.
● Inadequate sealing – Improper unit size may be difficult or impossible to achie.
In general, larger models achieve better seals with lower cuff inflation volumes or inflation pressures than smaller SGA models [5-7]
The solution to an insufficient seal may be to insert a larger SGA rather than inflate the cuff with more a.
A retrospective study of approximately 19,700 anesthetized patients involving the use of SGA showed an increased rate of SGA insertion failure with size 2 and 3 SGA [1
(See 'Selection of size' above) ● Patient anatomy – The patient's anatomy may make placement of the SGA difficu.
If placement difficulties exist, placement of a partially inflated LMA using rotational techniques [13] or placement with the aid of a fiberoptic laryngoscope or ultrasound [14] may be helpf.
Treatment Methods Improper positioning can sometimes be managed by repositioning the patient's head, repositioning the SGA, or adjusting the amount of air in the cu.
If in doubt, we recommend reinserting the SGA from scratch, or sometimes switching to endotracheal intubati.
Choice of ventilation mode — SGA can be used in both spontaneously breathing patients or in patients with P.
Because the SGA does not seal the pharynx, leaks around the device limit the pressure that can be safely used for ventilation, and leaks around the device can cause gastric inflation and/or hypoventilati.
Therefore, when the SGA is in the correct position, pressure-limited ventilation [ie, pressure support ventilation (PSV) or pressure-controlled ventilation (PCV)], rather than volume-controlled ventilation, is usually us.
The use of LMA during spontaneous breathing has several advantages: • The opioid dose can be gradually adjusted according to the patient's breathing ra.
● Rarely can cause gastroesophageal inflation proble.
●The possibility of air leakage around the SGA is less than when using P.
●Patients tolerate a certain degree of SGA misplacement bett.
On the other hand, the use of SGA devices for PPV has the following advantages: • PPV allows control of respiratory rate, tidal volume and minute ventilati.
●Hypoventilation can be avoided during deep anesthesia and when high doses of opioids are giv.
Many researchers have explored the application of the PPV+SGA devi.
Most LMAs and most other SGAs are designed for use at peak pressures below 20 cmH2O, and many studies have shown that leaks and gastric inflation occur minimally if peak pressures are maintained at 15-20 cmH
The LMA ProSeal is designed to allow use at higher ventilation pressures, and its cuff contains a posterior extension to achieve a "double seal" that allows peak airway pressures up to 25cmH2O without leaki.
Pressure-controlled ventilation — PCV is a mode of PPV commonly used in S.
With PCV, respiratory rate, peak inspiratory pressure, and other parameters can be s.
In contrast to volume-controlled ventilation, PCV prevents peak pressures that can lead to airway leaks and gastric inflati.
When the LMA is properly placed, the peak pressure is set at 15-20 cmH2O, and the respiratory rate is adjusted to achieve adequate minute ventilati.
Pressure support ventilation — We routinely use PSV when using SGA, but not all anesthesia ventilators support PSV mo.
In PSV mode, the patient initiates each breath and the ventilator provides additional support based on preset pressure valu.
A minimum number of breaths needs to be s.
In this mode, the patient controls their own respiratory rate and tidal volume, but if the resulting minute ventilation is too low, the minimum respiratory rate or level of pressure support can be increas.
A randomized crossover study comparing PSV with continuous positive airway pressure (CPAP) when using LMA showed that the CPAP setting was higher than end-expiratory ventilation when compared with spontaneous ventilation when CPAP was set at 5 cmH
The PSV gas exchange was more efficient when the positive end-expiratory pressure (PEEP) was 5 cmH
Use of neuromuscular blocking agents — To help prevent gagging, coughing, and laryngospasm, neuromuscular blocking agents (NMBAs) may be given to aid placement of the SGA, especially in certain situations (eg, thiopental sodium) for anesthesia inductio.
In addition, NMBA can be given to facilitate endotracheal intubation through the L.
A study evaluating the effect of NMBA administration during intubation of a cannulated LMA showed that the use of NMBA reduced patient coughing and movement during intubation and decreased the difficulty of removing the L.
NMBA may be helpful for PPV using SGA or to reduce the likelihood of laryngospasm during airway irritating procedures (eg, flexible bronchoscop.
NMBA is also used when the surgeon requires relaxation of the muscles to improve surgical exposu.
Misalignment clearly tells you that there are several possible misalignments of the LMA, as shown in Table Adjustments to the LMA Improperly positioned LMA may present with difficult ventilation (no respiratory movement or low tidal volume with high pressure) or low inspiratory pressure or large air leaks
In general, blindly (ie, no FOB), moving the LMA, or rotating are unlikely to correct the misalignment (see Table
A consequence of this is that accurate diagnosis of dislocation can only be done with the help of F.
How to Correct a Clearly Written LMA Correcting a mispositioned LMA should start with removing the mask completely before reinserting it:Make sure your LMA is the correct size, use weight-based guidelines, and refer to your own Preoperative airway examination and clinical judgme.
Inspect the LMA for damage and verify that the cuff is not leaking during inflati.
Depending on the type of LMA, you may want to form the hood into a smooth, flat wedge sha.
Lubricate the rear surface of the ma.
With the patient in the "sniffing flower" position, lift the neck and extend the head (see Figure
This position best aligns the oropharyngeal, laryngeal, and tracheal ax.
In larger patients, it is critical that the "inclined position" raises the ear canal above the level of the stern.
Adequately anaesthetize the patient - Insufficient anaesthesia, a taut state of the jaw will make placement of the LMA difficult or impossib.
Holding the LMA in a pen->
Slide the LMA along the hard palate, pushing it into the upper jaw as it advances down the phary.
Using your index finger as a guide for the tip of the LMA can help prevent the tip from collapsing and help push the tongue aw.
If the tip of the LMA is close to the posterior pharynx and not towards the vocal cords, place the index finger of the non-dominant hand behind the tip of the hypopharyngeal LMA so that the laryngeal mask tip is flexed forward, towards the vocal cords (in a "kick-and-shoot" motio.
; see Figure 5)Gently advance until resistance is encounter.
1 Inflate the cuff with the appropriate amount of a.
1 Verify proper placement with etco2 and auscultati.
OK did you learn? Welcome to leave a message to discuss your good method~ The previous link is the experience of Xiaowu school laryngeal mask (1) The status and history of Xiaowu school laryngeal mask experience (2) Those who have a high value and a variety of laryngeal masks~ Xiao Experience of Laryngeal Mask in Martial Arts Correct insertion method of the mask
