Summary
W e report a unilateral Iijpoglossal nerve paralpis following the use of a laryngeal mask airway in a 62
Key wordsComplications; paralysis, hypoglossal nerve. Equipment; laryngeal mask airway.As the use of laryngeal mask airway (LMA) increases [l, 23, so does the variety and incidence of complications [3-51. The LMA cuff is manufactured from silicone rubber, which absorbs volatile anaesthetics and nitrous oxide. Because the cuff is usually inflated with air, cuff volume and intracuff pressure increase temporarily during general anaesthesia with nitrous oxide [6]. A distended LMA cuff might damage the pharynx by compressing the soft pharyngeal tissue against a surrounding hard structure such as hyoid bone or vertebra. We report a case of hypoglossal nerve paralysis probably caused by Compression of the nerve between the LMA cuff and the hyoid bone.
Case historyA 62-year-old female, 151 cm tall and weighing 36 kg, with a 22-year history of rheumatoid arthritis, had undergone bilateral total hip joint replacement in the preceding 3 years. As a result of increasing pain in her left shoulder she was scheduled for a left total shoulder joint replacement. The pre-operative physical examination showed limited neck extension and mouth opening as a result of her disease, so a difficult tracheal intubation was anticipated and therefore we elected to maintain the airway during anaesthesia with a size 3 LMA. Two hours before the induction of anaesthesia, she received diazepam 5 mg orally and pethidine 35 mg intramuscularly, as premedication. To maintain anaesthesia, we chose continuous cervical epidural anaesthesia combined with general anaesthesia. Epidural anaesthesia was induced with mepivacaine through a catheter inserted at the C, , interspace. Initially 10 ml of 2% mepivacaine was injected and 5 ml was added every 45 min. After determining the effects of epidural anaesthesia, general anaesthesia was induced with thiopentone 200 mg, and suxamethonium 40 mg was used to prevent laryngospasm during insertion of the LMA. Initially, we were unable to obtain a good seal with the LMA, but at the second attempt the correct position was achieved, although there was slight resistance during insertion. The recommended 20 ml of air was injected into the LMA cuff and during surgery the patient received intermittent positive pressure ventilation with 67% nitrous oxide in oxygen, supplemented with pethidine 70 mg and midazolam 2.5 mg. Since leakage around the cuff was not observed even when the peak airway pressure exceeded 15 cmHzO, we changed her position from supine to the right lateral using an additional bolus of suxamethonium 20 mg. The patient was supported in position carefully using soft cushions, with a donut-type pillow under her head to prevent it from tilting down. Surgery was completed uneventfully within 3 h, the total blood loss was 160 ml and fluid replacement was 2450 ml. No significant changes in cardiovascular or respiratory parameters occurred during the operation and when spontaneous respiration and
A 72-year-old Japanese male developed disseminated herpes zoster and could not easily walk due to right drop foot and pain. He soon developed numbness and pain on the left side of his face, and noticed difficulty closing his left eye. The left angle of his mouth dropped. The patient was diagnosed as having a double mononeuropathy (a left facial nerve paresis and a right peroneal nerve paresis) following disseminated herpes zoster. Given that the patient was elderly and had diabetes mellitus, the patient appeared to be an immunocompromised host. We also describe other rare complications of herpes zoster from the published work.
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