A case report of upper airway obstruction following long-term use of LMA in surgery

Document Type : Case Report

Authors
Fatemeh Eftekharian 1
Navid Kalani 2
Reza Sahraei 3
1 Assistant Professor, Department of Internal Medicine, Jahrom University of medical sciences, Jahrom, Iran.
2 Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
3 Associated Professor, Department of Anesthesiology, Jahrom University of medical sciences, Jahrom, Iran
10.22034/pjms.2023.708498
Abstract
Introduction: Laryngeal spasm is the narrowing or complete closure of the glottis due to the reflex contraction of the
laryngeal muscles. The present study reports a case of upper airway obstruction following long-term use of a laryngeal mask airway in surgery.
Case Presentation: A 45-year-old female patient who referred to a urologist due to urological problems with complaints of urinary bleeding and pain in the urogenital area. Based on trusting the surgeon's words about the shortness of the surgery, a Laryngeal mask airway was used for the patient, and propofol was used to anesthetize the patient during the operation. The patient's surgery gradually took longer due to suspicion of malignancy in the urinary tract and bladder, and the surgeon extended the surgery almost every 15 minutes. Finally, the surgery was completed after nearly three hours, and despite the fact that the patient had not taken any special medicine except propofol an hour before the end of the operation, but when he woke up, he had difficulty breathing. Although the patient was completely relaxed with neostigmine and atropine, he had airway obstruction, especially in the upper part of the airway, just like asthma patients. Because the patient's breathing was severely disturbed, salbutamol spray, hydrocortisone ampoule (100 mg + 100 mg), aminophylline and finally epinephrine 5 micrograms were used for three doses, but the patient's breathing was still difficult and the patient had to be intubated after We received propofol and atracurium. After about 30 minutes passed and the conditions were suitable, we extubated the patient with special precautions and transferred him to the intensive care unit for recovery and for further assurance.
Conclusion: Based on the results of the present study, long-term use of Laryngeal mask airway is associated with the occurrence of laryngospasm after surgery, which can be considered as a result of long-term stimulation of the upper airway by the Laryngeal mask airway.
Keywords
Upper Airway Obstruction
Laryngeal Mask Airway
Laryngospasm
Surgery
1. Brain AI. The laryngeal mask-a new concept in
airway management. Br J Anaesth 1983; 55:801-5.
2. Brimamcombe J. The advantages of the LMA over
the tracheal tube or facemask: a meta-analysis. Can J
Anaesth. 1955; 42:1017–23
3. Springer D, Jahr JS. The laryngeal mask airway.
Safety, efficacy and current use. Am J Anesthesiol.
1995;22(2):65–9.
4. Lu PP, Brimacombe J, Yang C, Shyr M. ProSeal
versus the Classic laryngeal mask airway for positive
pressure ventilation during laparoscopic
cholecystectomy. Br J Anaesth.2002; 88(6):824–7.
5. Ye Q, Wu D, Fang W, Wong GTC, Lu Comparison
of gastric insufflation using LMA-supreme and I-gel
versus tracheal intubation in laparoscopic
gynecological surgery by ultrasound: a randomized observational trial. BMC Anesthesiol.
2020;3;20(1):136.
6. Viira D, Myles PS. The use of the laryngeal mask in
gynecological laparoscopy. Anaesth Intensive Care.
2004; 32(4):560–3.
7. Anand LK, Goel N, Singh M, Kapoor D. Comparison
of the Supreme and the ProSeal laryngeal mask airway
in patients undergoing laparoscopic cholecystectomy:
A randomized controlled trial. Acta Anaesthesiol
Taiwan. 2016; 54(2):44-50.
8. Oczenski W, Krenn H, Dahaba AA, Binder M, El-
Schahawi-Kienzl I, Kohout S, et al. Complications
following the use of the Combitube, tracheal tube and
laryngeal mask airway. Anesthesia.
1999;54(12):1161–5.
9. Birlie Chekol W, Yaregal Melesse D. Incidence and
associated factors of laryngospasm among
pediatricpatients who underwent surgery under
general anesthesia, in University of Gondar
Compressive Specialized Hospital, Northwest
Ethiopia, 2019: a cross-sectional study. Res Pract.
2020; 24;2020:3706106.
10. Visvanathan T, Kluger MT, Webb RK, Westhorpe
RN. Crisis management during anaesthesia:
laryngospasm. Qual Saf Health Care. 2005
Jun;14(3):e3.
11. Chilkoti GT, Mohta M, Janani S. Laryngospasm as
a Cause of Unsuccessful Placement of Laryngeal
Mask Airway ProSeal: A Case Report. AANA J.
2016; 1;84(6):420.
12. Abbasi S, Siddiqui KM, Qamar-Ul-Hoda M.
Adverse Respiratory Events After Removal of
Laryngeal Mask Airway in Deep Anesthesia Versus
Awake State in Children: A Randomized Trial.
Cureus. 2022;19;14(4):e24296.
13. Kitching AJ, Walpole AR, Blogg CE. Removal of
the laryngeal mask airway in children: anaesthetized
compared with awake. Br J Anaesth. 1996
Jun;76(6):874-6.
14. Samarkandi AH. Awake removal of the laryngeal
mask airway is safe in paediatric patients. Can J
Anaesth. 1998;45(2):150-2.
15. Kwanten LE, Madhivathanan P. Supraglottic airway
devices: current and future uses. Br J Hosp Med.
2018;79(1):31–35.
16. Yao CT, Wang JN, Tai YT, Tsai TY, Wu JM.
Successful management of a neonate with Pierre-
Robin syndrome and severe upper airway obstruction
by long term placement of a laryngeal mask airway.
Resuscitation. 2004;61(1):97-9.
17. Naaz S, Sahay N, Kumar R, Kumar A, Asghar A.
Prolonged Use of Supraglottic Airway Device for
Mechanical Ventilation in the Intensive Care Unit.
Indian J Crit Care Med. 2020 Oct;24(10):1001-1002.
18. Verghese C, Brimacombe JR. Survey of laryngeal
mask airway usage in 11,910 patients: safety and
efficacy for conventional and nonconventional usage.
Anest Analg. 1996; 82: 129-133
19. Brimacombe J, Archdeacon J. The LMA for
unplanned prolonged procedures. Can J Anaesth.
1995; 42: 1176
20. Afshan G, Chohan U, Qamar-Ul-Hoda M, Kamal
RS. Is there a role of a small dose of propofol in the
treatment of laryngeal spasm? Paediatr Anaesth. 2002
;12(7):625-8.
21 .Sundman E, Witt H, Sandin R. Pharyngeal function
and airway protection during subhypnotic
concentrations of propofol, isoflurane, and
sevoflurane: volunteers examined by pharyngeal
videoradiography and simultaneous manometry.
Anesthesiology. 2001;95:1125–32.
.22. Mihara T, Uchimoto K, Morita S, et al. The efficacy
of lidocaine to prevent laryngospasm in children: a
systematic review and meta-analy- sis. Anesthesia.
2014; 69:1388–96
23. Chung DC, Rowbottom SJ. A very small dose of
suxamethonium relieves laryngospasm. Anesthesia.
1993; 48:229–230.
24. Naguib M, Lien C. Pharmacology of Muscle
Relaxants and their Antagonists. In: Miller RD, ed.
Miller's Anesthesia. 6th ed. Philadel- phia, PA:
Elsevier/Churchill Livingstone; 2005:486–492