A Complication of Laryngeal Mask: Pharyngolaryngeal Rupture and Pneumomediastinum
Yunus Oktay Atalay1, Cengi̇z Kaya2, Serpi̇l Aktaş3, Kami̇l Toker4
1Department of Radiology, Outpatient anesthesia service, Ondokuz Mayis University, Samsun, Turkey
2Department of Anesthesiology, Ondokuz Mayis University, Samsun, Turkey
3Department of Anaesthesiology, The Private Emsey Hospital, Istanbul, Turkey
4Department of Anaesthesiology, Kocaeli University, Kocaeli, Turkey
AIM: The most important problems with laryngeal mask airway (LMA) use occur during insertion and/or removal. A very rare case of pharyngolaryngeal rupture, pneumomediastinum, and widespread subcutaneous emphysema is presented as a complication of LMA use. CASE: A 72-year-old man, weight 80 kg, ASA 2 had undergone cystoscopy under general anaesthesia due to hematuria and globe vesicale. After standard ASA monitoring and induction with fentanyl, propofol, and 10 mg rocuronium, a size 4 LMA classic was easily inserted at the first attempt. The cuff manometry was not used during the operation. In the first hour of the operation, peak airway pressure progressively increased up to 30 cm H₂O and abdominal distension and subcutaneous emphysema developed. The LMA was deflated, 30 mg of rocuronium was administered, and the patient was intubated orotracheally. Free air was seen in the abdominal cavity by intraoperative abdominal ultrasonography. The patient was transferred to the intensive care unit with orotracheal intubation, and extubated after two hours. A chest X-ray and computerized tomography revealed no pneumothorax, but widespread pneumomediastinum, subcutaneous emphysema running from the cervical region to the anterior abdominal wall, and pneumoperitoneum were observed (Fig.1). No contrast material leakage from the lumen was seen on the esophageal passage radiography. Mucosal erosion in the left posterolateral region of the pharynx was monitored with a flexible scope examination. The subcutaneous emphysema of the patient improved, and he was discharged to the ward next day. CONCLUSION: Inflating the LMA cuff lower than the maximal volumes and monitoring the cuff pressure with cuff manometry can help to avoid severe mucosal damage of the pharynx. will reduce laryngopharyngeal complications and increase the patient’s comfort and the quality of the anesthesia.
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