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Author Topic: LMA in cardiac surgery  (Read 4497 times)

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chiragdr69

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LMA in cardiac surgery
« on: April 15, 2007, 01:22:48 AM »
I would like to have discussion on the usefulness of LMA in cardiac surgery,particularly how safe is it ,when we are aiming at fasttracking in cardiac surgery
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Noyac

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Re: LMA in cardiac surgery
« Reply #1 on: May 23, 2007, 12:50:08 PM »
Are you serious?

It sure is going to be hard for the pt to breath spontaneously with their chest open.  Remember, the diaphragm works by causing negative intrathoracic pressure which expands the lungs.  Whats going to expand the lungs without the closed chest cavity?

Are you planning on ventilating through the LMA?  If so then just put a tube in.
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hemanayakulu

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Re: LMA in cardiac surgery
« Reply #2 on: November 26, 2007, 04:39:43 PM »
Sir,
 If you want to use LMA for caradiac surgeries, you can use it with controlled ventilation . But, why you want to ventillate the pt with LMA when regular intubation is comfortable and safe.
                                                                 Hemanayakulu.
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jafo1964

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Re: LMA in cardiac surgery
« Reply #3 on: November 28, 2007, 11:43:16 PM »
Who says you cant fast-track if you intubate the trachea.
All your cases that you intubate for non-cardiac surgeries you extubate at the end of surgery. Dont You?

Fast tracking in cardiac surgeries is dependant on lot of other factors like haemodynamics, extent of myocardial repairs, inotorpic support, arrhythmias etc. Not merely the presence or absence of ETT.

With so much of lung retraction for cardiac surgery how can you acheive adequate peak inflation pressure to ventilate adequately with LMA - results in inadequate alveolar ventialtion
In classic LMA permitted peak inflation press is 18 cm H2O.
In proseal LMA permitted peak pressure is 30.

Spontaneous ventilation is not desired in cardiac surgery. LMA and spont vent is usually associated with hypercarbia usually between 50 to 60 mmHg. This is definitely unacceptable in cardiac surgery

SO doctor , current scientific evidence showing safe practice both for your patient and you is
Intubate cardiac surgery patients with cuffed ETT, control ventilation
end of surgery if they meet all required criteria for fast tracking
reverse and extubate

WHO KNOWS WHAT THE FUTURE SCIENTIFIC EVIDENCE HOLDS IN STORE

regards
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