I am going to play devils advocate.

Let's say you are performing a mask induction, you get the patient deep, or what
you believe to be deep enough, insert the LMA and the patient still
laryngospasms. You have no IV, the patient ends up either having a
tracheostomy, neurologically impaired, or dead. (yes I realize these are
extreme)

I don't believe this is defensible.

By the same token, educating surgery folks on how to start an IV or having them
correctly hold mask and assist ventilation, while you personally start the IV
seems a lot less potentially problematic.

Am I too conservative?

Juan F. Quintana MHS, CRNA
SLEEPY ANESTHESIA ASSOCIATES PLLC
Office: 903-725-3595 Fx: 903-725-3599
a_sleeper2@...

"We are what we repeatedly do. Excellence, then, is not an act, but a habit."
Aristotle


--- On Sun, 9/7/08, James Anderson <jsandersonmdelp@...> wrote:

> From: James Anderson <jsandersonmdelp@...>
> Subject: Re: [ai] pediatric SGA question
> To: Anesthideas@yahoogroups.com
> Date: Sunday, September 7, 2008, 1:42 PM
> I routinely place LMAs and even intubate on occasion prior
> to IV
> placement.
> In my private practice environment, the circulating nurse
> or the
> surgeon are the only alternatives to me. So the choice is
> to try to
> manage the airway and start the IV at the same time (which
> can be done
> if the IV is easy), or get the patient deep, place the
> airway, then
> start the IV.
> If the patient is sufficiently deep, laryngospasm is not a
> problem.
>
>
> Steve
>
>
>
>
>
> On Sep 7, 2008, at 10:12 AM, Ivan Hronek wrote:
>
> >
> > I wonder what people's experiences with pediatric
> airways are: is it
> > safe to insert a SGA (supraglottic airway, like an
> LMA) prior to
> > insertion of an i.v. ?
> > In other words: has anyone experienced serious
> complications such as
> > severe bradycardia, laryngospasm or similar that
> would mean it is
> > wrong to insert a SGA prior to inserting an i.v. ?
> >
> > Ivan Hronek MD
> >
> > Los Angeles, CA
> >
> > http://health.groups.yahoo.com/group/Anesthideas/
> >
> >
> > Do not fear to be eccentric in opinion, for every
> opinion now
> > accepted was once eccentric. - Bertrand Russell-
> >
> >
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents
> > may be confidential and contain information protected
> by State and
> > Federal Medical Privacy statutes and is legally
> privileged. They are
> > intended for use only by the addressee. If you are not
> the intended
> > recipient of this transmission, or an agent of the
> intended
> > recipient, you are prohibited from reading,
> disclosing, printing,
> > saving, copying, using, or otherwise disseminating any
> information
> > contained in this transmission. If you received this
> transmission in
> > error, please accept our apologies and notify me at
> ivanhronek@...
> > and delete the entire message and its attachments.
> Thank
> > you.Disclaimer: this message contains the personal
> views of the
> > author. The author will not be responsible in any way
> for procedures
> > or approaches perfomed in the way suggested in this
> note.
> >
> >
> >
> >
> >
> >
> >