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[yogenbhatt1]

Hi,
Anybody tried insertion of LMA in prone position?
Read an article in Indian Journal of Anst Dec 2008??
Was impressed with the study. Read and read over and over again. They had used LMA Classic in the study of 200 cases with only two cases where they had to reinsert, in variety of cases inclusive Spine and in obese patients.
We made up our mind to try once. We use LMA Supreme. This is much better shaped device. We do Liposuction in obese patients in prone position first and later in supine position.
We tried it in a case. Made the patient sleep in prone position and then induced her. It was easy to ventilate ( as the tongue does not fall back, it rises in prone)and very easy to insert the LMA. We connected the patient to venti.
The patient was in prone for an hour and half, and all was ok.
We made her supine and completed the surgery of front in next 2 hours.
It was most easy.
We tried it in about a dozen cases after that and are happy.
The idea is to try it once, so that one is not afraid, if ever a tube gets dislodged in prone, you can always insert an LMA and manage the case.
Sounded like a creazy idea to start with, but the article was presented nicely and we were tempted in trying it.
Please let me know if any one has tried, and if any difficulties.
Regs.

[kalpesh shah]

Hi, it is extremly craditable job in private practice. requires lots of self confidence.

regards

[dimple parekh]

Hi,
Anybody tried insertion of LMA in prone position?
Read an article in Indian Journal of Anst Dec 2008??
Was impressed with the study. Read and read over and over again. They had used LMA Classic in the study of 200 cases with only two cases where they had to reinsert, in variety of cases inclusive Spine and in obese patients.
We made up our mind to try once. We use LMA Supreme. This is much better shaped device. We do Liposuction in obese patients in prone position first and later in supine position.
We tried it in a case. Made the patient sleep in prone position and then induced her. It was easy to ventilate ( as the tongue does not fall back, it rises in prone)and very easy to insert the LMA. We connected the patient to venti.
The patient was in prone for an hour and half, and all was ok.
We made her supine and completed the surgery of front in next 2 hours.
It was most easy.
We tried it in about a dozen cases after that and are happy.
The idea is to try it once, so that one is not afraid, if ever a tube gets dislodged in prone, you can always insert an LMA and manage the case.
Sounded like a creazy idea to start with, but the article was presented nicely and we were tempted in trying it.
Please let me know if any one has tried, and if any difficulties.
Regs.

SIR i ll have to first come n see how u do .n when i attempt i lll have to keep an anaesthesia team with me.jokes apart sir how about the risk of aspiration .how do we explaine .its like our argument over lma in laproscopy or not

[yogenbhatt1]

Hi,
Everyone always speaks of aspiration, when ever LMA is discussed. I do not deny the possibility, but it is an over cautious feel. We have been, off late using LMA supreme, which has a gastric channel. Over my very frequent use of LMA in Gynaec  lap surgeries, once I have seen gastric juice coming out of Gastric channel. I put in a catheter in the channel and sucked it out.
Another thing, aspiration in prone position? Mother gravity helps it coming out of the mouth and not in the trachea.
Lot of hypothetic worry, but once you get used to it you will prefer LMA over a tube.And does a tube prevent Aspiration???

[yogenbhatt1]

HI,
Funny things happen when you try newer things.
I managed to break two LMA Supreme, half way down the surgery. Suddenly from no where the venti started sounding disconnection alarm. On examination under panic, we found that the LMA had broken at its neck and was not possible to ventilate any more.
We immediately replaced it by LMA Classic and managed to ventilate, but it gives a fright, specially half way in the surgery, with the patient draped and access to reintubate was difficult.
Be careful about LMA Supreme, its neck is delicate.

[frontier]

sir,
 Don't you think its unsafe practice.regards

[Dr. Mian]

A topic which is near and dear to my heart,

I commonly use the flexible LMA for SHORT prone procedures (mostly kypho/vertebroplasty); I do not have experience inserting it in the prone position although I can see the utility of this (pt. can position themselves); I make sure I have a very good fit, can PPV, and tape it well.  I tend to avoid it in obese pt's (uncommon with osteoporosis). As far as aspiration, gravity should allow for external drainage.  As regards laryngospasm, I avoid desflurane and like to think if it occured, I could give some succ and PPV.

Welcome comments.

[yogenbhatt1]

HI,
It is great to know that some one does use LMA in prone in regular practice. We insert it in prone. Now a  days we only use LMA Supreme. It is easy to insert as it has a shape of tongue depressor.  Easier than an Airway, which has to be turned in the throat during insertion. Keep the head lateral, let some one give a short tilt of head and the LMA walks in smoothly.
Movie cant be shown on this site. Do let me know if you need to see a few pictures during insertion.
Regards

[yogenbhatt1]

Feel great to be able to open the site after a big lapse.
Just to inform that now we have done a series of 165 cases of insertion of LMA in Prone position.
We have never had to intubate the patient. All were managed successfully. No more broken LMA SUPREME. may be we learned the tricks. Last 5 cases we used INTUBATING LMA because surgeon wanted to do liposuction of Chin, where he was not happy because the LMA cuff was altering the shape of Chin. We intubated these patient just before the Chin part. For trial we intubated all of them in Prone only just to see if it was possible. The first case was difficult as we had not used the tube pusher, and the Tube and LMA both came out. We reinserted LMA and reintubated. The next cases were easy, as we had learned the trick.
Just to emphasize that this can also be done if needed. No need to do as a routine.

[equipmentexplained.com]

I think anything can be done with any airway device if you try hard enough. For an example, you could do a patient in prone position with a face mask ! THe question is, how easily can you correct a LMA in the prone position if it dislodges ? A ET tube is much more secure in that respect and is less likely to need adjustment unless something dramatic happens. .

[gastech79]

woulkdnt recommend it

[yogenbhatt1]

Writing after a verry long time.
Nor would I recommend it as you said.
I want you to try it once, in presence of a friend for safety.
So that you can intubate a patient in case an ETT ever comes out in prone.
Or if a PCNL is being done in Spinal and the effect is not too good or going down, you may need to intubate.
There are many a things that can go wrong. today you may get time to learn, tomorrow when things go wrong, you may not get time.
So might as well try it out and always be confident that you will be able to put an LMA in prone position.
LMA Supreme and Ambu are easiest to insert in prone.
Best Wishes.

[Bicarb]

it's probably a "can do" but if something goes wrong it's problably difficult to explain why one didn't make use of a conventional tracheal tube...

[yogenbhatt1]

HI,
There are two concerns.
One is Aspiration. Mother Gravity takes care of it. Nothing can go backward in the trachea.
Second is displacement. It was easy to insert in the the first place, it is equally easy second time and more.
One has to do it once to feel that it is so easy though unconventional.
There are always so many other ways of doing every thing that we all do in general, which had a better way of doing it.
Are we playing with life?
No way. and there are so many international papers supporting this.

[mcsleepy]

We now do it routinely for prone GA cases (microdiscectomies, achilles tendon repair, etc).  We also induce in the prone position, with the gurney aside the OR table, and insert the LMA after the patient is asleep.  THe patient is able to tell us if anything is uncomfortable prior to induction so we don't have to worry about nerve stretch or any body part being compressed between the Wilson Frame.  We have had good results, and haven't had to turn the patient supine in any of the approximately 30 cases we've done so far.  We are in an ambulatory surgery center, and it speeds time to prep and incision.  No regurgitation so far, and if they did it would come out their mouth.  It's actually much safer regarding aspiration than the prone position.