Have you ever used muscle relaxant with LMA? Is muscle relaxant contraindicated with the use of LMA? We all know what is the answer in the textbook: the use of muscle relaxant in LMA case would not be supported. But recent studies have shown that the use of muscle relaxant with LMA cases are beneficial for several reasons. One is to facilitate the placement of LMA by suppressing the coughing, gagging reflex. In addition, it appeared that the use of low-dose muscle relaxant could reduce the ventilation leak for mechanical ventilation with FLMA. Lastly, on a morbidly obese patient, low dose muscle relaxant makes it easier to ventilate the patient.
I have been using 20mg succinylcholine to facilitate my LMA placement on the big muscular guy and I found that it was a lot easier to place it correctly with ease compared to without it. Lately, I started to use small dose of rocuronium 10mg on morbidly obese patient in some of the LMA cases. One of the attendings have taught me this trick and it worked wonders. I didn’t have to worry about desaturation due to inadequate tidal volume with PSV mode.
Do you also use muscle relaxant in your practice with LMA cases? Please let me know your thoughts and comments.
Effect of low dose rocuronium in preventing ventilation leak for flexible laryngeal mask airwayduring radical mastectomy. Gong YH, Yi J, Zhang Q, Xu L. Int J Clin Exp Med. 2015 Aug 15;8(8):13616-21. eCollection 2015.
Muscle relaxant effects on insertion efficacy of the laryngeal mask ProSeal(®) in anesthetized patients: a prospective randomized controlled trial. Fujiwara A, Komasawa N, Nishihara I, Miyazaki S, Tatsumi S, Nishimura W, Minami T. J Anesth. 2015 Aug;29(4):580-4. doi: 10.1007/s00540-015-1982-3. Epub 2015 Feb 10.