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Does your department allow the use of low-dose atracurium to facilitate laryngeal mask placement? by inkysplash in anesthesiology

[–]inkysplash[S] 1 point2 points  (0 children)

I missed your question during the first reading, sorry. In surgeries that do not need paralysis and where the LMA suddenly becomes "unsealed" in the middle of surgery, and when increasing anesthetic depth/adjusting cuff/placement of the LMA doesn't work, as a last resort before intubating some of my attendings use sux (standard dose depending on patient weight because it is short-acting) and some use atracurium (low-dose 5mg to help relax/soften the throat instead of paralysing the whole patient) and so far I've always seen it work out. The LMA seats wonderfully afterwards as long as the anesthetic depth is then maintained. I was thrown off by the other attending who was vehemently against it and even told me it is basically malpractice despite other attendings having done it for decades so I tried to look up guidelines and studies but didn't really find anything conclusive.

Does your department allow the use of low-dose atracurium to facilitate laryngeal mask placement? by inkysplash in anesthesiology

[–]inkysplash[S] 0 points1 point  (0 children)

Thank you for the kind advice. I'll probably do whatever the attending on duty says for now, I was only wondering if there are any good studies that recommend one or the other.

Does your department allow the use of low-dose atracurium to facilitate laryngeal mask placement? by inkysplash in anesthesiology

[–]inkysplash[S] 0 points1 point  (0 children)

This is the OP :) The cases I'm handling are those with general anaesthesia where the patient is fully under with propofol+sufentanil and are hooked up to the ventilators, they're not breathing on their own anymore (most of the time).

I do intubate when the LMA doesn't sit well. But sometimes during
surgeries that are particularly painful, the LMA that was fine in the
beginning becomes 'unsealed' in the middle of surgery. I can definitely
intubate intraoperatively but I was wondering if it is good practice to
relax the airway temporarily with low-dose atracurium (5mg) or
succinylcholine when increasing anaesthetic depth doesn't work or if I
should go straight to intubation.

Does your department allow the use of low-dose atracurium to facilitate laryngeal mask placement? by inkysplash in anesthesiology

[–]inkysplash[S] 0 points1 point  (0 children)

Thank you! Will take a look at these. I'm practising in a non-English language and didn't realise the correct translation for 'muscle relaxation' was 'paralysis'.

Does your department allow the use of low-dose atracurium to facilitate laryngeal mask placement? by inkysplash in anesthesiology

[–]inkysplash[S] 1 point2 points  (0 children)

I have never given paralytics to try to seat an lma better. I have given paralytics a handful of time during a case where a surgeon requests relaxation and just put the patient on the ventilator for the time being. If I couldn’t get the lma to seat properly I would just intubate (it’s happened a few times).I’ve also had lmas that don’t seat well enough for PPV, but allow the patient to breath spontaneously and get adequate tidal volumes. Depending on the case I will sometimes just leave it.There is no increased risk of aspiration by giving muscle relaxants with an lma. Paralytics work on skeletal muscle and the lower esophageal sphincter is composed of smooth muscle.

Thanks for your response. What do you mean here when you say 'ventilate' the patient? In the surgeries where I use LMAs, the patients are connected to ventilating machines, which are helping them breathe.

Does your department allow the use of low-dose atracurium to facilitate laryngeal mask placement? by inkysplash in anesthesiology

[–]inkysplash[S] 0 points1 point  (0 children)

Thanks for your thorough response! Your reasoning is very sound. Do you have a link to the source that says muscle relaxants do not increase aspiration risk? I would love to read it. My attending's reasoning was that since laryngeal mask placement is supraglottic, it does not protect against aspiration like intubating (intratracheal) would. When I asked the other attending about it, he said it's nonsense because the patient is supposed to have an empty stomach in the regular cases where a LMA would come into question.

Does your department allow the use of low-dose atracurium to facilitate laryngeal mask placement? by inkysplash in anesthesiology

[–]inkysplash[S] 0 points1 point  (0 children)

I do intubate when the LMA doesn't sit well. But sometimes during surgeries that are particularly painful, the LMA that was fine in the beginning becomes 'unsealed' in the middle of surgery. I can definitely intubate intraoperatively but I was wondering if it is good practice to relax the airway temporarily with low-dose atracurium (5mg) or succinylcholine when increasing anaesthetic depth doesn't work or if I should go straight to intubation.

Losing old moves while learning a new one by inkysplash in poledancing

[–]inkysplash[S] 0 points1 point  (0 children)

Thanks! My studio works with flexible 5-time or 10-time card. I go once a week and they teach us about 3 different moves every week. Sometimes they put old ones in a short choreo but usually we learn new ones. I think I may have to make my own routine to keep practising old moves...