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 9 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.