A survey of laryngeal mask airway use by anaesthesia practitioners at Kenyatta National Hospital
Abstract
Background: The LMA is an airway management device that is indicated for achieving
and maintaining control of the airway during routine and emergency anaesthetic
procedures in patients who are not at risk of regurgitation and aspiration. This being a
fairly new device, there is variability in how anaesthesia practitioners use it at KNH.
Objective: To determine the clinical practice patterns of the use of the LMA Classic
(LMA) by anaesthesia practitioners at Kenyatta National Hospital (KNH). Specifically,
the study sought to find out the indications, insertion, ventilation practices and removal
techniques. Adverse effects experienced during LMA use and limitations hindering its
use were also surveyed.
Methods: This is a cross sectional descriptive survey of anaesthesia practitioners at the
anesthesia department of KNH on the use of the LMA. The study population included
physician anaesthesiologists, clinical officer anaesthetists and senior post-graduate
students in the anaesthesia program. Data was collected by use of a questionnaire that
was administered to the anaesthesia practitioners. Data collected was analyzed by use of
Microsoft Excel spreadsheet and Statistical Package for Social Sciences.
Results: Fifty two anaesthesia practitioners were surveyed. 36% were Physician
anaesthesiologists, 29% were clinical officer anaesthetists and 35% were part two postgraduate
anaesthesia students. The LMA is used by 82% of anaesthesia practitioners. Of
the respondents who use the LMA, 100% of them use it in adult patients, 86% of them
use it in paediatric patients, 2.3% of them use it in laparoscopic surgery, 11.6% of them
use it in open abdominal surgery, 34.8% of them use it in obese patients, 72% of them
use the LMA as a rescue device when routine airway management fails. Muscle
relaxants are used by 37% of LMA users to aid placement. 46% of those who use the
LMA lubricate both its anterior & posterior surfaces. The LMA was used in spontaneous
ventilation by all users and in IFPV by 34% of users. LMA is removed when patient is
fully awake by 37.2% of users with 51% removing it with the cuff deflated. Common
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adverse incidences experienced by users during LMA use were laryngospasms by 44.1 %,
inadequate seal during IPPV by 44.1 %, failed LMA use requiring tracheal intubation by
44.1 %, gastric insufflation by 37% and frequent difficulty in inserting the LMA by 34.8%
'Elf users. Inadequate training in LMA use was indicated to limit LMA use by 78% of
practitioners. Over emphasis on tracheal tube or face mask anaesthesia was indicated to
limit LMA use by 75% of practitioners. Unavailability of the LMA or correct size of
LMA was indicated as limiting LMA use by 73% of practitioners.
Recommendations: The whole range of LMA sizes should be available in all theatres.
More training in LMA use is required. KNH should come up with practice guidelines on
LMA use.