LMA Use

[JSlimmon]

Does the PediaSIM respond to LMA use?

Our service uses LMA as the second-line airway intervention in peds (after OPA) and while trying to develop a simulation allowing this, I have found that the air leaks in the upper airway and does not go to the lungs. I double checked placement with laryngoscopy and found that the LMA sits nicely around the epiglottis and area, but there is no chest rise with ventilations.

Could there be a problem with the airway or does it not work with LMA's?

Thanks,

Jeff Slimmon
Field Trainer, Patient Care Simulation
The City of Calgary EMS

[ntekancic]

Mr. Slimmon:

An LMA can be used on the PediaSIM. There should not be a problem with chest excursion when using an LMA. There can be one of two problems. The first is if the LMA is seated correctly. (you have indicated that the LMA is correctly seated). The second is programming the mannequin. What are you using to sustain the need for airway intervention? If you are using a laryngospasm or broncho occlusion this will prevent any air movement from an artificial means (Ambu) from entering into the lungs. To eliminate the problem and allow air flow, simply disable these features during ventilation.

Nicholas Tekancic
Cllinical Educator - METI

[JSlimmon]

Hi Nicholas,

Thanks for the quick reply.

The situation that I had set up was making the patient apneic by setting Fixed Neuromuscular Blockade to 100%. There was no adjustment to laryngospasm or bronchial occlusion. When ventilated with an OPA, there was visible chest rise (and corresponding increases in left and right lung volume). However, when an LMA was inserted there was no visible chest rise or abdominal distension and the lung volumes didn't change.

We tried a couple of different sizes, but to confirm, is #2 the recommended size?

Jeff

[kev]

Hi Jeff,

I have found that you need to put a little bit of extra air into the cuff ( to seat it well), and ensure you are using some airway spray to seat it. This has worked well for me.
Hope this helps

Kevin

[ntekancic]

Please see response below

[ntekancic]

A #2 is the recommended size. It appears that the LMA is not seating correctly. You may want to try to use an airway occlusion to aid in the sealing of the LMA.