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Castillo-Monzón CG, Gaszyński T, Marroquín-Valz HA, Orozco-Montes J, Ratajczyk P. Supraglottic Airway Devices with Vision Guided Systems: Third Generation of Supraglottic Airway Devices. J Clin Med 2023; 12:5197. [PMID: 37629238 PMCID: PMC10455808 DOI: 10.3390/jcm12165197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Supraglottic airway devices are currently widely used for airway management both for anaesthesia and emergency medicine. First-generation SADs only had a ventilation channel and did not provide protection from possible aspiration of gastric content if regurgitation occurred. Second-generation SADs are equipped with a gastric channel to allow the insertion of a gastric catheter and suctioning of gastric content. Additionally, the seal was improved by a change in the shape of the cuff. Some second-generation SADs were also designed to allow for intubation through the lumen using fiberscopes. Although the safety and efficacy of use of SADs are very high, there are still some issues in terms of providing an adequate seal and protection from possible complications related to misplacement of SAD. New SADs which allow users to choose the insertion scope and control the position of SAD can overcome those problems. Additionally, the Video Laryngeal Mask Airway may serve as an endotracheal intubation device, offering a good alternative to fibre-optic intubation through second-generation SADs. In this narrative review, we provide knowledge of the use of video laryngeal mask airways and the possible advantages of introducing them into daily clinical practice.
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Affiliation(s)
- Caridad G. Castillo-Monzón
- Service of Anaesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, 30202 Murcia, Spain;
| | - Tomasz Gaszyński
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| | | | - Javier Orozco-Montes
- Service of Anaesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, 30202 Murcia, Spain;
| | - Pawel Ratajczyk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
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Xian L, Yuan J, Li H, Gao Z, He J, Deng H. Unilateral sublingual nerve paralysis after laryngeal mask airway in a patient with congenital heart disease: a case report. J Int Med Res 2023; 51:3000605231190899. [PMID: 37561563 PMCID: PMC10416657 DOI: 10.1177/03000605231190899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
Laryngeal masks are widely used by anesthesiologists in clinical practice because of their advantages of no tracheal injury, minimal airway stimulation, limited airway tissue invasion, and easy implantation and airway establishment. We herein describe a patient with congenital heart disease who developed unilateral sublingual nerve paralysis after application of a laryngeal mask airway. The patient reported perioral numbness and exhibited unclear speech and slight right deviation of the tip of the tongue after surgery. On physical examination, the patient had normal muscle strength, symmetrical frontal lines, normal occlusion, and a normal nasolabial groove. We performed head computed tomography and computed tomography angiography to rule out cerebrovascular disease, and no abnormalities were found. The patient's imaging findings and clinical symptoms suggested unilateral right sublingual nerve palsy. After active treatment, the patient's symptoms improved by 75% on the third postoperative day and by 90% on the fifth postoperative day. Despite the extremely low incidence of sublingual nerve palsy after application of a laryngeal mask airway, anesthesiologists should be aware of this complication. Although the nerve palsy can resolve spontaneously, the nerve damage may be permanent.
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Affiliation(s)
- Li Xian
- Department of Anesthesiology, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Jinlong Yuan
- Department of Anesthesiology, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Hong Li
- Department of Anesthesiology, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Zhiyong Gao
- Department of Anesthesiology, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Jing He
- Department of Nursing, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Haijun Deng
- Department of Nursing, No. 363 Hospital, Sichuan Province, Chengdu, China
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Gorbea E, Mori M. Two Cases of Bilateral Vocal Fold Mobility Impairment After LMA Use In 7 Months. Ann Otol Rhinol Laryngol 2018; 127:653-656. [PMID: 30047792 DOI: 10.1177/0003489418784061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To increase awareness of vocal fold mobility impairment secondary to laryngeal mask airway (LMA) use in the operating room. METHODS We report 2 cases of bilateral vocal fold mobility impairment after LMA use within 7 months of each other. One patient is a 52-year-old female who developed this complication after orthopedic elbow surgery. The second case is a 75-year-old male who presented after undergoing inguinal hernia repair. RESULTS The patient from the first case required a 7-day hospital stay in the SICU due to airway compromise with spontaneous resolution of right-sided vocal fold immobility and improvement of symptoms. The 75-year-old male required direct laryngoscopy and bilateral true vocal fold injection medialization to correct his bilateral vocal fold paresis causing dysphonia and aspiration of liquids. CONCLUSIONS Bilateral vocal fold immobility secondary to LMA use is likely an underreported phenomenon of which otolaryngologists and anesthesiologists should be aware. Presentation may be severe, requiring hospitalization or operative intervention.
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Affiliation(s)
- Enrique Gorbea
- 1 Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Matthew Mori
- 1 Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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Garg J, Liew GHC, Khan SA. Greater palatine nerve neuropraxia after laryngeal mask insertion: A rare occurrence. Indian J Anaesth 2017; 61:930-932. [PMID: 29217860 PMCID: PMC5703008 DOI: 10.4103/ija.ija_364_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
With the more frequent use of the laryngeal mask airway (LMA) over endotracheal tubes for general anaesthesia, various cranial nerve injuries have been reported recently. We report a rare occurrence of greater palatine nerve (GPN) palsy subsequent to the use of LMA Supreme™ in a young female scheduled for hand surgery. Although the exact mechanism of a nerve injury is still a matter of further research, we postulate pressure neuropraxia of GPN as a causative factor in the development of numbness over the hard palate after the removal of LMA in the post operative period.
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Affiliation(s)
- Jyoti Garg
- Department of Anesthesia and Intensive Care, Sengkang General Hospital, Singapore
| | | | - Shariq Ali Khan
- Department of Anesthesia and Intensive Care, Singapore General Hospital, Singapore
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Bae GE, Shin HW, Lim HH, Ju BJ, Jang YK. Predicting the optimal minimal cuff volume of the laryngeal mask airway from physical examination parameters. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Go Eun Bae
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyong Hwan Lim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Bum Jun Ju
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoo Kyung Jang
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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Continuous neuropathic pain secondary to endoscopic procedures: report of two cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:e55-9. [PMID: 27422430 DOI: 10.1016/j.oooo.2016.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/14/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
Neuropathic pain encompasses a spectrum of conditions that can arise from a lesion or dysfunction of the central or the peripheral nervous system, and it may develop at variable intervals after nerve injury or inflammation. Nerve injuries arising from surgical procedures commonly occur secondary to the surgical trauma, and in rare instances they are a complication of intubation during general anesthesia or endoscopic procedures. A series of 2 cases of bilateral glossopharyngeal neuropathic pain subsequent to endoscopic procedures is presented with a review of the literature concerning the mechanisms of development of neuropathic pain after these procedures. The purpose of these case reports is to make dentists aware of the occurrence, the mechanisms of nerve injuries, and the treatment of neuropathic pain after endoscopic procedures. In the first case, the patient had relief of pain with a combination therapy of clonazepam 1.0 mg in divided doses twice daily and gabapentin 300 mg in divided doses 3 times daily. In the second case, the patient had significant relief of pain with a monotherapy of gabapentin 1200 mg in divided doses 3 times daily.
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Venugopal A, Jacob RM, Koshy RC. A randomized control study comparing the pharyngolaryngeal morbidity of laryngeal mask airway versus endotracheal tube. Anesth Essays Res 2016; 10:189-94. [PMID: 27212745 PMCID: PMC4864682 DOI: 10.4103/0259-1162.174466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Endotracheal tube (ETT) has been associated with various pharyngolaryngeal morbidities (PLMs) following general anesthesia (GA). Laryngeal mask airway (LMA), currently the most commonly used supraglottic airway device, has several advantageous over the ETT but has been associated with varying results of PLM. The aim of our study was to compare the PLM between them and to know whether LMA is a better alternative. Materials and Methods: One hundred and seventy American Society of Anesthesiologists Grades 1 and 2 women scheduled for elective mastectomy were included in the study, 85 each in either group, E Group (intubated with ETT) and L Group (using LMA) on a random basis. All patients received GA with controlled ventilation using a muscle relaxant. PLMs such as hoarseness, pain on phonation, sore throat, and difficulty in swallowing were documented by an interview done postoperatively. Peroperative parameters such as intubation attempts, trauma during airway device insertion, and intraoperative incidents were also analyzed. A sample size of 85 patients in each group was calculated in order to achieve a study power of 0.8 and alpha level was taken as 0.05. Data were analyzed using SPSS version 16 using Chi-square test, Mann–Whitney U-test and Fisher's exact test were used as nonparametric tests. A two-tailed P< 0.05 was considered significant. Results: Patients in E Group had statistically significant increased incidence of a sore throat and voice complaints whereas L Group showed a statistically significant increase of swallowing problems. There was also a significant correlation between traumatic insertion and sore throat, pain on swallowing in the L Group, which could be due to direct trauma. Conclusions: ETT was associated with an increased incidence of voice problems and sore throat whereas LMA had an increased incidence of dysphagia and odynophagia. Use of LMA changes the pharyngolaryngeal profile to a more acceptable one.
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Affiliation(s)
- A Venugopal
- Department of Anaesthesiology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Ron Mathew Jacob
- Department of Anaesthesiology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Rachel Cherian Koshy
- Department of Anaesthesiology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Unilateral Vocal Cord Paralysis following Insertion of a Supreme Laryngeal Mask in a Patient with Sjögren’sSyndrome. Case Rep Anesthesiol 2016; 2016:8185628. [PMID: 28018681 PMCID: PMC5149601 DOI: 10.1155/2016/8185628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 11/07/2016] [Indexed: 12/02/2022] Open
Abstract
Since its introduction in 1988 by Dr. Archie Brain, the laryngeal mask airway (LMA) is being used with increasing frequency. Its ease of use has made it a very popular device in airway management and compared to endotracheal intubation it is less invasive. The use of LMA was on the rise, so has been the incidence of its related complications. We report severe unilateral vocal cord paralysis following the use of the supreme laryngeal mask (sLMA) in a patient with Sjögren's syndrome. In addition, we propose possible mechanisms of injury, review the existing case reports, and discuss our findings.
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Jadhav PA, Dalvi NP, Tendolkar BA. I-gel versus laryngeal mask airway-Proseal: Comparison of two supraglottic airway devices in short surgical procedures. J Anaesthesiol Clin Pharmacol 2015; 31:221-5. [PMID: 25948905 PMCID: PMC4411838 DOI: 10.4103/0970-9185.155153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Supraglottic airway devices have been established in clinical anesthesia practice and have been previously shown to be safe and efficient. The objective of this prospective, randomized trial was to compare I-Gel with LMA-Proseal in anesthetized spontaneously breathing patients. MATERIAL AND METHODS Sixty patients undergoing short surgical procedures were randomly assigned to I-gel (Group I) or LMA- Proseal (Group P). Anesthesia was induced with standard doses of propofol and the supraglottic airway device was inserted. We compared the ease and time required for insertion, airway sealing pressure and adverse events. RESULTS There were no significant differences in demographic and hemodynamic data. I-gel was significantly easier to insert than LMA-Proseal (P < 0.05) (Chi-square test). The mean time for insertion was more with Group P (41 + 09.41 secs) than with Group I (29.53 + 08.23 secs) (P < 0.05). Although the airway sealing pressure was significantly higher with Group P (25.73 + 02.21 cm of H2O), the airway sealing pressure of Group I (20.07 + 02.94 cm of H2O) was very well within normal limit (Student's t test). The success rate of first attempt insertion was more with Group I (P < 0.05). There was no evidence of airway trauma, regurgitation and aspiration. Sore throat was significantly more evident in Group P. CONCLUSION I-Gel is a innovative supraglottic device with acceptable airway sealing pressure, easier to insert, less traumatic with lower incidence of sore throat. Hence I-Gel can be a good alternative to LMA-Proseal.
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Affiliation(s)
- Poonam A Jadhav
- Department of Anaesthesiology, LTMMC and LTMG Hospital, Sion, Mumbai, Maharashtra, India
| | - Naina P Dalvi
- Department of Anaesthesiology, LTMMC and LTMG Hospital, Sion, Mumbai, Maharashtra, India
| | - Bharati A Tendolkar
- Department of Anaesthesiology, LTMMC and LTMG Hospital, Sion, Mumbai, Maharashtra, India
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Thiruvenkatarajan V, Van Wijk RM, Rajbhoj A. Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series. Anaesthesia 2014; 70:344-59. [DOI: 10.1111/anae.12917] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
Affiliation(s)
- V. Thiruvenkatarajan
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - R. M. Van Wijk
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - A. Rajbhoj
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
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11
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Unilateral hypoglossal nerve palsy after use of the laryngeal mask airway supreme. Case Rep Anesthesiol 2014; 2014:369563. [PMID: 25254120 PMCID: PMC4164424 DOI: 10.1155/2014/369563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/25/2014] [Indexed: 12/27/2022] Open
Abstract
Purpose. Hypoglossal nerve palsy after use of the laryngeal mask airway (LMA) is an exceptionally rare complication. We present the first case of unilateral hypoglossal nerve palsy after use of the LMA Supreme. Clinical Features. A healthy 67-year-old female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. A size 4 LMA Supreme was inserted successfully at the first attempt and the cuff was inflated with air at an intracuff pressure of 60 cmH2O using cuff pressure gauge. Anesthesia was maintained with oxygen, nitrous oxide (67%), and sevoflurane under spontaneous breathing. The surgery was uneventful and the duration of anesthesia was two hours. The LMA was removed as the patient woke and there were no immediate postoperative complications. The next morning, the patient complained of dysarthria and dysphasia. These symptoms were considered to be caused by the LMA compressing the nerve against the hyoid bone. Conservative treatment was chosen and the paralysis recovered completely after 5 months. Conclusion. Hypoglossal nerve injury may occur despite correct positioning of the LMA under the appropriate intracuff pressure. A follow-up period of at least 6 months should be taken into account for the recovery.
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Thiruvenkatarajan V, Van Wijk RM, Elhalawani I, Barnes AM. Lingual nerve neuropraxia following use of the Laryngeal Mask Airway Supreme. J Clin Anesth 2014; 26:65-8. [DOI: 10.1016/j.jclinane.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 10/24/2013] [Accepted: 10/29/2013] [Indexed: 12/19/2022]
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Upadhyay SP, Mallick PN, Jagia M. Unusual bulging (ballooning) of the laryngeal mask airway cuff causing secondary loss of airway. Indian J Anaesth 2012; 56:193-4. [PMID: 22701217 PMCID: PMC3371501 DOI: 10.4103/0019-5049.96328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Surjya Prasad Upadhyay
- Department of Anaesthesiology and Critical Care, Al Jahra Hospital, Ministry of Health, Kuwait
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Cook T, MacDougall-Davis S. Complications and failure of airway management. Br J Anaesth 2012; 109 Suppl 1:i68-i85. [DOI: 10.1093/bja/aes393] [Citation(s) in RCA: 269] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Hanumanthaiah D, Masud S, Ranganath A. Inferior alveolar nerve injury with laryngeal mask airway: a case report. J Med Case Rep 2011; 5:122. [PMID: 21447166 PMCID: PMC3073919 DOI: 10.1186/1752-1947-5-122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 03/29/2011] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The incidence of damage to the individual cranial nerves and their branches associated with laryngeal mask airway use is low; there have been case reports of damage to the lingual nerve, hypoglossal nerve and recurrent laryngeal nerve. To the best of our knowledge we present the first reported case of inferior alveolar nerve injury associated with laryngeal mask airway use. CASE PRESENTATION A 35-year-old Caucasian man presented to our facility for elective anterior cruciate ligament repair. He had no background history of any significant medical problems. He opted for general anesthesia over a regional technique. He was induced with fentanyl and propofol and a size 4 laryngeal mask airway was inserted without any problems. His head was in a neutral position during the surgery. After surgery in the recovery room, he complained of numbness in his lower lip. He also developed extensive scabbing of the lower lip on the second day after surgery. The numbness and scabbing started improving after a week, with complete recovery after two weeks. CONCLUSION We report the first case of vascular occlusion and injury to the inferior alveolar nerve, causing scabbing and numbness of the lower lip, resulting from laryngeal mask airway use. This is an original case report mostly of interest for anesthetists who use the laryngeal mask airway in day-to-day practice. Excessive inflation of the laryngeal mask airway cuff could have led to this complication. Despite the low incidence of cranial nerve injury associated with the use of the laryngeal mask airway, vigilant adherence to evidence-based medicine techniques and recommendations from the manufacturer's instructions can prevent such complications.
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Affiliation(s)
| | - Sarmad Masud
- Department of Anaesthesia, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Anil Ranganath
- Department of Anaesthesia, Cork University Hospital, Cork, Ireland
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A Randomised, Single-blind, Controlled Trial of Silicone Disposable Laryngeal Masks during Anaesthesia in Spontaneously Breathing Adult Patients. Anaesth Intensive Care 2009; 37:992-7. [DOI: 10.1177/0310057x0903700604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We hypothesised that two new silicone disposable laryngeal mask airways, Meditech Systems Limited (MSL) and ProAct (PA), would perform similarly to the Classic™ Laryngeal Mask Airway (cLMA) in spontaneously breathing adult patients. One hundred and twenty consecutive adult patients were prospectively enrolled and randomly allocated to one of three groups (PA, MSL, cLMA). All patients received a standardised anaesthetic and insertion technique. The overall success rates were 97.5% for all three masks, with one failure of laryngeal mask airway insertion in each group. There was no statistical difference in airway sealing pressures between the PA laryngeal mask airway (17.9±5.9 cmH2O), MSL laryngeal mask airway (18.5±6.9 cmH2O) and cLMA (17.6±5.6 cmH2O) (P=0.816). There was no statistical difference in insertion times, ease of insertion, cuff pressure and cuff volumes. The MSL and PA disposable laryngeal mask airways provided comparable airway sealing pressures to the reusable cLMA.
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Lee AKY, Tey JBL, Lim Y, Sia ATH. Comparison of the Single-use LMA Supreme with the Reusable ProSeal LMA for Anaesthesia in Gynaecological Laparoscopic Surgery. Anaesth Intensive Care 2009; 37:815-9. [DOI: 10.1177/0310057x0903700537] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Laryngeal Mask Airway Supreme (LMAS) is a new, single-use laryngeal mask airway with gastric access. We conducted a randomised controlled study comparing the LMAS with the reusable ProSeal Laryngeal Mask Airway (PLMA) in 70 patients undergoing general anaesthesia with paralysis for gynaecological laparoscopic surgery. Our primary outcome measure was the oropharynegal leak pressure. We also compared the two devices for ease of insertion, adequacy of ventilation and incidence of complications. Both devices had similar rates of successful insertion at the first attempt (LMAS 94% vs PLMA 91%). There was no difference in the time to establish an effective airway (LMAS 25±22 vs PLMA 24±9 seconds), although gastric tube insertion was faster for the LMAS (5±1 vs 7±3 seconds, P <0.001). The mean oropharyngeal leak pressure in the LMAS was significantly lower than in the PLMA (27.9±4.7 vs 31.7±6.3 cmH2O, P=0.007). This was consistent with a lower maximum tidal volume achieved with the LMAS (481±76 vs 515±63 ml, P=0.044). We found that after 60 minutes the cuff pressure was significantly higher in the PLMA (110±21 vs 57±8 cmH2O, P <0.001). There was no difference in the ability to provide adequate ventilation and oxygenation during anaesthesia. Complication rates were similar. We conclude that the oropharyngeal leak pressure and the maximum achievable tidal volume are lower with the LMAS than with the PLMA.
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Affiliation(s)
- A. K. Y. Lee
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
- Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital
| | - J. B. L. Tey
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Y. Lim
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - A. T. H. Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
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Janakiraman C, Chethan DB, Wilkes AR, Stacey MR, Goodwin N. A randomised crossover trial comparing the i-gel supraglottic airway and classic laryngeal mask airway. Anaesthesia 2009; 64:674-8. [DOI: 10.1111/j.1365-2044.2009.05898.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mun CS, Kim HT, Heo HE, Lee JH, Kwon YE. Unilateral vocal cord palsy occurred after difficult endotracheal intubation using intubating laryngeal mask airway: A case report. Korean J Anesthesiol 2009; 56:200-203. [PMID: 30625722 DOI: 10.4097/kjae.2009.56.2.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Airway management is important during general anesthesia. Difficulties with a direct laryngoscopy can be managed successfully in a routine manner using a laryngeal mask airway. A 65-year-old woman was scheduled to undergo gynecologic surgery. After injecting the intravenous induction agents and muscle relaxants, intubation was attempted with a direct laryngoscope. However, the vocal cords could not be observed with only the epiglottis being slightly visible. Although intubation was re-attempted by another anesthesiologist, it failed. Intubation was successfully performed via an intubating laryngeal mask airway (ILMA) after additional 100% oxygen mask ventilation. We report a case of vocal cord palsy subsequent to tracheal extubation after endotracheal intubation via ILMA.
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Affiliation(s)
- Cheol Sin Mun
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea.
| | - Hyung Tae Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea.
| | - Hyeon Eon Heo
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea.
| | - Jun Hak Lee
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea.
| | - Young Eun Kwon
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea.
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Schmidbauer W, Bercker S, Volk T, Bogusch G, Mager G, Kerner T. Oesophageal seal of the novel supralaryngeal airway device I-Gel in comparison with the laryngeal mask airways Classic and ProSeal using a cadaver model. Br J Anaesth 2008; 102:135-9. [PMID: 19011262 DOI: 10.1093/bja/aen319] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Supraglottic airway devices are increasingly used in anaesthesia and emergency medicine. This study was designed to investigate the oesophageal seal of the novel supralaryngeal airway device, I-Gel (I-Gel), in comparison with two of the laryngeal mask airways, Classic (cLMA) and ProSeal (pLMA), in a model of elevated oesophageal pressure. METHODS The three supralaryngeal airway devices were inserted into eight unfixed cadaver models with exposed oesophagi that had been connected to a water column producing both a slow and a fast oesophageal pressure increase. The pressure applied until the loss of oesophageal seal during a slow and fast pressure increase was measured. RESULTS During the slow increase of pressure, the pLMA withstood an oesophageal pressure up to a median of 58 cm H(2)O, while the cLMA was able to block the oesophagus up to a median of 37 cm H(2)O, and I-Gel already lost its seal at 13 cm H(2)O. One minute after maximum pressure had been applied, the pLMA withstood an oesophageal pressure of 59 cm H(2)O, the cLMA of 46 cm H(2)O, and I-Gel airway of 21 cm H(2)O. A fast release of oesophageal fluid was accomplished through the oesophageal lumen of both the pLMA and I-Gel. CONCLUSIONS Both the pLMA and cLMA provided a better seal of the oesophagus than the novel I-Gel airway. The pLMA and I-Gel drain off gastrointestinal fluid fast through the oesophageal lumen. Thus, tracheal aspiration may be prevented with their use. Further study is necessary.
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Affiliation(s)
- W Schmidbauer
- Department of Emergency Medicine, Bundeswehrkrankenhaus, Berlin, Germany.
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23
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The Laryngeal Mask Airway: Prehospital and Emergency Department Use. Emerg Med Clin North Am 2008; 26:1069-83, xi. [DOI: 10.1016/j.emc.2008.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Endo K, Okabe Y, Maruyama Y, Tsukatani T, Furukawa M. Bilateral vocal cord paralysis caused by laryngeal mask airway. Am J Otolaryngol 2007; 28:126-9. [PMID: 17362820 DOI: 10.1016/j.amjoto.2006.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 06/28/2006] [Accepted: 07/05/2006] [Indexed: 11/19/2022]
Abstract
The laryngeal mask airway (LMA) is regarded as a safer supraglottic airway for general anesthesia compared with conventional endotracheal tubes. We report a case of bilateral vocal cord palsy temporarily observed after using the LMA, which required urgent tracheotomy. Severe swelling of the arytenoid suggested that bilateral recurrent laryngeal nerve palsy was caused by prolonged compression on the pyriform fossa. One month later, vocal cord movements were fully recovered. It should be noted that bilateral vocal cord palsy is a possible complication associated with use of the LMA.
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Affiliation(s)
- Kazuhira Endo
- Department of Otolaryngology, Kouseiren Takaoka Hospital, Toyama, Japan.
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25
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Hachwa B, Halim-Armanios M. Bilateral vocal cord injury following anterior cervical discectomy: could a better preoperative exam have prevented it? Libyan J Med 2006. [DOI: 10.3402/ljm.v1i2.4674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bachar Hachwa
- Department of Anesthesiology, the Ohio State University Medical Center, Columbus, Ohio, USA
| | - Mona Halim-Armanios
- Department of Anesthesiology, the Ohio State University Medical Center, Columbus, Ohio, USA
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26
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Hachwa B, Halim-Armanios M. Bilateral vocal cord injury following anterior cervical discectomy: could a better preoperative exam have prevented it? Libyan J Med 2006; 1:156-61. [PMID: 21526013 PMCID: PMC3081355 DOI: 10.4176/061106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 10/30/2006] [Indexed: 11/30/2022] Open
Abstract
We present a rare case of bilateral vocal cord injury (BVCI) following anterior cervical discectomy with fusion (ACD/F) in a 47 year old man. The patient experienced post-extubation stridor and whispering voice in the recovery room. Clinical assessment led to the diagnosis of BVCI. The patient was treated by tracheostomy and made a full recovery. What is unique about this case is that the patient had no reason for a preexisting unilateral vocal cord injury (UVCI) prior to this surgery. There have been only two similar cases in the English literature in which the patients had a preexisting unilateral vocal cord paralysis (UVCI). We recommend a more detailed preoperative airway exam to include a voice exam with specific voice fatigue questioning on all patients coming for ACD/F. Such detailed assessment may uncover hidden UVCI and allow a safer perioperative period.
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Affiliation(s)
- Bachar Hachwa
- Department of Anesthesiology, the Ohio State University Medical Center, Columbus, Ohio, USA
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27
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Palmer OD, Whittaker V, Pinnock C. Early Perioperative Care of the Acutely Injured Maxillofacial Patient. Oral Maxillofac Surg Clin North Am 2006; 18:261-73, vii. [DOI: 10.1016/j.coms.2006.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Levitan RM, Kinkle WC. Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff. Anaesthesia 2005; 60:1022-6. [PMID: 16179048 DOI: 10.1111/j.1365-2044.2005.04258.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The I-gel airway is a novel supraglottic airway that uses an anatomically designed mask made of a gel-like thermoplastic elastomer. We studied the positioning and mechanics of this new device in 65 non-embalmed cadavers with 73 endoscopies (eight had repeat insertion), 16 neck dissections, and six neck radiographs. A full view of the glottis (percentage of glottic opening score 100%) occurred in 44/73 insertions, whereas only 3/73 insertions had epiglottis-only views. Including the eight repeat insertions with a different size, a glottic opening score of > 50% was obtained in all 65 cadavers. The mean percentage of glottic opening score for the 73 insertions was 82% (95% confidence interval 75-89%). In each of the neck dissections and radiographs the bowl of the device covered the laryngeal inlet. We found that the I-gel effectively conformed to the perilaryngeal anatomy despite the lack of an inflatable cuff and it consistently achieved proper positioning for supraglottic ventilation.
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Affiliation(s)
- R M Levitan
- Albert Einstein Medical Center, Emergency Medicine Department, 5501 Old York Road, Philadelphia, PA 19141, USA
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29
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Brimacombe J, Clarke G, Keller C. Lingual nerve injury associated with the ProSeal laryngeal mask airway: a case report and review of the literature. Br J Anaesth 2005; 95:420-3. [PMID: 16006489 DOI: 10.1093/bja/aei187] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a case of lingual nerve injury that was associated with use of the ProSeal laryngeal mask airway during shoulder replacement in a 61-yr-old male. We also review other cases of cranial nerve injury, most of which were associated with use of the classic laryngeal mask airway. In principle, the frequency of cranial nerve injuries can be reduced by avoiding insertion trauma, using appropriate sizes, minimizing cuff volume, and early identification and correction of malposition.
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Affiliation(s)
- J Brimacombe
- Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Queensland, Australia.
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30
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Kawauchi Y, Nakazawa K, Ishibashi S, Kaneko Y, Ishikawa S, Makita K. Unilateral recurrent laryngeal nerve neuropraxia following placement of a ProSeal laryngeal mask airway in a patient with CREST syndrome. Acta Anaesthesiol Scand 2005; 49:576-8. [PMID: 15777310 DOI: 10.1111/j.1399-6576.2005.00616.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a severe unilateral recurrent laryngeal nerve neuropraxia following use of the ProSeal laryngeal mask airway (PLMA) in a 71-year-old female patient with CREST syndrome. She required amputation of the 5th phalanx of foot because of gangrene due to Raynaud's syndrome. Anesthesia was induced with propofol, and a size 3 PLMA was inserted. Anesthesia was maintained with sevoflurane and nitrous oxide for 2 h and the operation was performed uneventfully. On removal of PLMA, the cuff volume was measured to 40 ml. The patient did not complain of respiratory discomfort shortly after PLMA removal. However, the next day she developed dysphagia and hoarseness. Laryngoscopic examination revealed unilateral vocal cord paralysis. Cricothyrotomy was required because of suspected silent aspiration pneumonia. The pharyngolaryngeal complications improved with a mobile vocal cord but slight hoarseness after 2 months. We considered the patient's CREST syndrome with a potential of tissue ischemia, and the high intracuff pressure of the PLMA due to nitrous oxide influx, to be the cause of severe recurrent laryngeal nerve neuropraxia in this case.
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Affiliation(s)
- Y Kawauchi
- Department of Anesthesiology and Critical Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
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31
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Trümpelmann P, Cook T. Unilateral hypoglossal nerve injury following the use of a ProSeal™ laryngeal mask. Anaesthesia 2005; 60:101-2. [PMID: 15601291 DOI: 10.1111/j.1365-2044.2004.04056.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lacau Saint Guily J, Boisson-Bertrand D, Monnier P. [Lesions to lips, oral and nasal cavities, pharynx, larynx, trachea and esophagus due to endotracheal intubation and its alternatives]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22 Suppl 1:81s-96s. [PMID: 12943864 DOI: 10.1016/s0750-7658(03)00163-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dysphagia of greater than 48 h duration is an indication for indirect laryngoscopy and when odynophagia and otalgia occur simultaneously, the possibility of subluxation of the arytenoids demands an urgent ENT assessment. The potential seriousness of laryngeal lesions following intubation obliges us to use the smallest compatible endotracheal tube. The occurrence of pain cervical surgical emphysema and fever suggests a pharyngeal lesion necessitating the suspension of oral feeding and the initiation of antibiotic therapy with anaerobic activity, while awaiting possible surgical intervention. There is no argument to use a tooth-guard for each intubation, but tooth fragility must be researched. The incidence of nasal fossa trauma is reduced with the use of nasal packs impregnated with local anaesthetic containing a vasoconstrictor. This allows the introduction of a small flexible lubricated tube. Laryngeal mask-induced sore throat is more common than the more serious injuries. The classical technique of introducing a laryngeal mask of appropriate size (4 for women, 5 for men) in which the cuff is inflated to a leak pressure of 20 cm H(2)O reduces this frequency. The facial mask may cause injuries especially with prolonged use. The incidence of pulmonary aspiration, linked to the action of drugs, raised intra-abdominal pressure; an emergent situation or difficult intubation is decreased with the performance of the Sellick maneuver at intubation, rapid induction and the neutralization of gastric acidity. A meticulous technique of insertion of the, individualized anaesthesia, particular vigilance at the time of decurarisation and position changes and a calm awakening assure its optimal use, unless the Proseal laryngeal mask modifies this point of view.
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Affiliation(s)
- J Lacau Saint Guily
- Service d'ORL et chirurgie cervico-faciale, hôpital Tenon, 75970 Paris cedex 20, France
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Abstract
Safe and effective airway management techniques have become a hallmark of modern anesthesiology practice, but even such overwhelmingly successful and life-saving practices come with a cost. This cost is morbidity and mortality secondary to the techniques themselves. Closed claims analysis has shown that adverse outcomes secondary to respiratory events constitute the single largest source of injury to patients (75%). Airway management complications are a significant subset of these outcomes. Difficult intubation was shown to be a factor in only slightly more that one third (38%) of these claims. Six percent of closed claims were for airway trauma. These data indicate that injury frequently occurs without initial difficulty in management of the airway, may occur throughout the perioperative period, and can be unexpected when it occurs. Thorough knowledge of the mechanisms of airway injury associated with different airway management techniques may allow for better patient outcomes. This chapter reviews complications of airway management involving the placement of endotracheal tubes. In addition, because laryngeal mask airways (LMAs) have gained increasing prominence in airway management use in the past 10 years, complications relating to their use will also be reviewed.
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Affiliation(s)
- Stanley Weber
- Department of Anesthesiology, University of Pittsburgh, A-1305 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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35
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Affiliation(s)
- T Asai
- Department of Anaesthesiology, Kansai Medical University, Moriguchi City, Osaka 570-8507, Japan; Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Queensland, Australia
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36
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Sacks MD, Marsh D. Bilateral recurrent laryngeal nerve neuropraxia following laryngeal mask insertion: a rare cause of serious upper airway morbidity. Paediatr Anaesth 2000; 10:435-7. [PMID: 10886703 DOI: 10.1046/j.1460-9592.2000.00550.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of a 4-year-old boy who developed bilateral recurrent laryngeal nerve neuropraxia following a routine anaesthetic with a laryngeal mask airway. The possible mechanisms of injury and the ways that this rare but critical complication might be avoided are discussed.
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Affiliation(s)
- M D Sacks
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, London, UK
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37
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Twigg S, Brown JM, Williams R. Swelling and cyanosis of the tongue associated with use of a laryngeal mask airway. Anaesth Intensive Care 2000; 28:449-50. [PMID: 10969377 DOI: 10.1177/0310057x0002800417] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a case report of a patient who developed acute swelling of the tongue during anaesthesia using the laryngeal mask airway. The swelling was thought to be due to obstruction of the venous drainage of the tongue. This was associated with isolated cyanosis of the tongue and paraesthesia. The swelling and cyanosis of the tongue resolved rapidly after removal of the laryngeal mask airway. The patient suffered paraesthesia of the tip of the tongue that lasted for two weeks.
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Affiliation(s)
- S Twigg
- Department of Anaesthesia, Southmead Hospital, Westbury on Trym, Bristol, U.K
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38
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The laryngeal mask airway for outpatient otolaryngologic surgery. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200006000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Abstract
Over the last decade there has been significant advancement in airway management and a recent closed claims analysis indicates a decrease in claims since the 1980s. Studies and new airway devices have focused on managing the difficult airway and the failed intubation, problems which are common to the trauma patient. Although new airway devices have improved our ability to ventilate these patients, they are not 100% reliable nor do they provide a definitive airway. Formal training in airway management and the use of these airway devices has much room for improvement. With increased emphasis on training and the development of improved intubating aids, modern management of the difficult airway may approach 100% success.
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Affiliation(s)
- V Shearer
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9068, USA
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