LMAs, Ventilators, and Pediatric Strabotomies

Icon at St. Sava - photo by JoAnn Sturman

Scott Sturman, M.D.

When the LMA was introduced into anesthesia practice, it allowed us to care for small children undergoing strabismus surgery without intubation.  The question remained how to best handle dead space and the accumulation of CO2.  Spontaneous ventilation allowed for a quick transfer at the conclusion of the case to PACU, but CO2 levels climbed much too high, and the depth of anesthesia proved unsatisfactory.

Assisted ventilation improved the situation, but it was not until the ventilator was used in the non paralyzed patient that physiologic levels of CO2 and reasonable depths of anesthesia could be attained.  Tidal volumes were adjusted to keep inspiratory pressures below 15 cm H2O.  Despite controlled ventilation, spontaneous ventilation usually returned within a few minutes when the ventilator was discontinued, and the patient transferred without delay to PACU.

Now with the advent of the PVS Pro ventilator mode, return to spontaneous ventilation is nearly instantaneous.  And there is nothing like meperidine 1mg/kg IM (up to 25 mg max) at this time to preemptively smooth the emergence phase in the recovery room.

Osijek, Croatia - photo by JoAnn Sturman