As discussed here before, we are fairly conservative with regards to SGA use and surgery for a variety of reasons, but mainly due to fear of the risk of aspiration of gastric contents. At the VA for example who does not report that has GERD? The question is do we really know if an SGA is contraindicated in such patients and also do we really know whether they should be used in certain surgical procedures such as laparoscopic surgery? The article I am posting today deals with some of these issues. Look forward to your comments.
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Nov
Once again let us discuss the issue of SGA use and aspiration
6 Responses to “Once again let us discuss the issue of SGA use and aspiration”
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Associate Professor of Anesthesiology at the University of Florida; I did my residency then fellowship in Cardiothoracic anesthesia, completed a Masters In Education at UF in 2012 and have been a UF/VA staff anesthesiologist since 2000. I was also the Director of the Master of Education Fellowship from the C.O.M. until the course was terminated. I am responsible for the Difficult Airway Rotation at the UF and Airway Management Services at the NFSGVHS. My interests include: 1-Airway related topics 2-Education about Airway management 3- Resident training in Airway management 4-Non-Anesthesia providers airway training and education 5-Education in general and specifically technology in education.
I almost have enough experience as an attending to try something that may get me into a bit of trouble… so I accept the challenge! I will use LMA’s with somewhat less conservative exclusion criteria in the near future. We will use them in cases that would not be typical at the VA and gain first-hand experience with the positives and negatives of these applications. The literature seems to defend LMA use in a much more broad range of procedures than I have personally utilized them in thus far.
Posted on November 7th, 2009 at 2:28 pmPick wisely grasshopper
Posted on November 7th, 2009 at 4:34 pmI think the issue for us residents would be convincing the majority of our attendings to let us try a SGA in what they would still think is a “contraindication”.
Posted on November 8th, 2009 at 11:25 amAahh! you bring an interesting point. That is when making a copy of an article or pointing to the article posted on this blog to the attendings not willing to try it might help. You at least can say I gave it a try and I know the literature is with me. That is also why in this educational project I have a section of classic articles.
Posted on November 8th, 2009 at 11:53 amIf one reads this article carefully, one may be reminded that there were exclusion criteria where the LMA was not used – like small bowel obstruction, among others. It is entirely unclear to me that the same patients in the ETT group were excluded from the analysis – atg least I did not see it explicitly stated. This is a provocative article but the groups may not be as well alligned as one would like or hope: the ett group had 2 deaths while the LMA group had none. It is hard for me to imagine this is all Hoyle, even though the n is large in both groups.
Posted on November 9th, 2009 at 12:32 amSo true, but airway literature is gray, lots of opinions (some even educated), little concrete evidence; one has to accept not so perfect design of groups etc… because in reality it is difficult to carry out studies that are RC. Observational studies have a lot of value too. I am going to use the old cliche: I have not seen a study that compares the need to use a parachute to jump from a plane, or one that compares the use of a cape to fight a bull, because how would you have a control group for such a study? Having said this and with all the respect to the authors and editors, these combined studies with prospectively derived retrospective data…. I dunno!, but that is why I posted the article in the first place to post controversy.
Posted on November 9th, 2009 at 5:45 am