LMA to stoma ventilation

Level 1 evidence is great, but for useful tips that can add options to your resuscitation toolbox there are some great finds in journal letters pages.

Try this one: An apneoic patient requires assisted ventilation in your resuscitation room. Bag-mask ventilation is ineffective. You then notice a mature tracheostomy at the same time that you’re told he had a laryngectomy. How would you ventilate him?

The obvious answer is to intubate the stoma with a size 6.0 tracheal tube or a tracheostomy tube if you have one. However prior to that you could bag-‘mask’ ventilate with a size 2 laryngeal mask airway applied to the stoma, holding the cuff in place with pressure through an index finger.

Such a technique is desribed in the context of an elective anaesthesia case in this month’s Anaesthesia. The LMA cuff provided an effective seal around the stoma, thereby allowing leak-free ventilation.

Stoma ventilation using a paediatric facemask is another option.

Tracheostomy ventilation using a laryngeal mask as a ‘bridge to extubation’
Anaesthesia 2010;65(12):1232–1233

This entry was posted in General PH&RM and tagged , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s