LMA in dental surgery

(Sep-2004 Q10) Justify the use of a laryngeal mask airway in a 25 yo, 80kg man having general anaesthesia for removal of 4 molar teeth.


Anaesthetic indications:
Use of a LMA in this case is less invasive than endotracheal intubation. As this surgery is most likely in the setting of ambulatory surgery, this reduces the need of muscle relaxation, reduces morbidity from sorethroat, especially if the patient is obese and is potentially difficult to intubate. The option of a flexible LMA also allows the tube to be manipulated away from the side of surgery.

Provided that the adequacy of spontaneous ventilation can be achieved to maintain adequate depth of anaesthesia.

The surgeon also has to be agreeable to the use of a supragottic device and is vigilant about suctioning of wash and secretions.

supraglottic devices, if used with adequate depth of anaesthesia, causes a lower risk of laryngospasm.

increased turnover time
easier to insert,

contraindications to LMA: patient with reflux.
disadvantages: less secure airway-may dislodge or kink, shared airway and limited access, secretions, leak with higher airway pressures (esp if obese)