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light" with an SGA in. Usually it's the young strapping lad who bends
the normally straight SGA tube into a 90-degree angle with his teeth.
While this may seem innocuous and he'll let go eventually, the negative
inspiratory pressure during his attempts at inspiration against an
obstructed tube can result in negative-pressure pulmonary edema. Not
something you want to have happen in the elective SGA case. I've seen
everything from using multiple tongue blades placed on top of each
other to "wedge" open the mouth to a rapid bolus of IV propofol or nar-
cotic throwing the patient back into apnea. What works best in my
opinion is 10 mg of IV succinylcholine. It works fast and only lasts long
enough to push in a few breaths of your volatile anesthetic of choice to
get the patient back to a safe anesthetic depth before pulling the SGA
or continuing the surgery.
Lube where the tube
meets the mask of the SGA.
To effectively place an SGA, you have to use some lube for
placement. But don't place gobs of lube on the back of the mask and
tip of the SGA. Not only does this do little to help with placement, but
it can be a risk for partial laryngospasm. The portion of the SGA that
needs the most lube during placement is the portion of the tube just
distal to the mask. This portion sees the most friction going in against
the palate. Placing a small amount of lube where the tube meets the
mask will ease insertion and avoid any unintentional partial laryn-
gospasms.
Doing a bronchoscopy case? Use an
SGA.
Bronchoscopy cases can be challenging. There have been 2
prevailing ways to do these cases: straight sedation and with an endo-
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D I F F I C U L T A I R W A Y S