I use muscle relaxants with LMAs all of the time and I am criticized for doing so, although when I ask the critics why I should not, they have no data to support their criticism.
I believe LMAs actually work better when the patient is relaxed. Light anesthesia and poor relaxation contribute to LMA malfunction.
This link will bring you to a pdf taken from the LMA of North America website that supports my position on this:
LMA use with muscle relaxants
Detractors are encouraged to leave a comment to this post.
An interesting article and an editorial from Anesthesia Analgesia:
It is becoming more clear that the hyperchloremia associated with infusion of normal saline is not benign:
Hyperchloremic metabolic acidosis is not a benign, self-limiting, metabolic disturbance. We found that acute postoperative hyperchloremia in patients undergoing noncardiac surgery was associated with increased mortality, renal dysfunction, and length of hospital stay.
As the editorial points out, several things are clear:
- hyperchloremia is more common with 0.9% saline than with balanced crystalloid solutions
- hyperchloremia is associated with worse outcomes
- there are better alternatives to 0.9% saline in most clinical situations (excluding hypochloremic metabolic alkalosis)
- until an adequately powered randomized clinical trial proves us wrong, 0.9% saline will not be our crystalloid of choice for intravascular volume resuscitation in surgical patients.