Vocal fold palsy after use of the laryngeal mask airway

Daya, Hamid; Fawcett, William; Weir, Neil

doi:10.1017/s0022215100133699

Cited by 40 publications

(34 citation statements)

References 9 publications

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“…Related airway morbidity ranges from sore throat 2 h after anaesthesia to more serious complications such as paralysis of vocal cords and the hypoglossal nerve, and dislocation of the arytenoid cartilages [9][10][11][16][17][18][19][20]. There are limited data on the relationship between pharyngeal intracuff pressures, pressure exerted by the cuff on the laryngo-pharyngeal mucosa and mucosal perfusion pressure [20,21].…”

Section: Discussionmentioning

confidence: 99%

Nitrous oxide diffusion into the cuffs of disposable laryngeal mask airways

Maino¹,

Dullenkopf²,

Bernet

et al. 2005

Anaesthesia

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SummaryThe aim of this study was to investigate cuff pressure changes found in disposable size 3 laryngeal mask airways (LMAs) from different manufacturers during nitrous oxide exposure and to compare the results with the re-usable Classic LMA. In an in vitro experiment, laryngeal mask airway cuff pressures starting from a baseline pressure of 40 cm H 2 O were recorded using a pressure transducer for 60 min with the laryngeal mask airway cuff exposed to 66% N 2 O in oxygen. Cuff pressure increases within 5 min of nitrous oxide exposure were > 250% in the Classic LMA and were not significantly different from those found in the Marshall laryngeal mask airway. However, they were significantly greater than those in the Soft Seal, the Unique, the AMBU, and Intersurgical laryngeal mask airways, all of which demonstrated stable cuff pressure levels within the first 5 min. The cuff pressure increase following 60 min of nitrous oxide exposure was 13.0 ± 1.1 and 14.6 ± 0.7 cm H 2 O in the Intersurgical and Unique laryngeal mask airways, respectively, which was significantly lower than the cuff pressure increase in the Soft Seal and in the Ambu laryngeal mask airways (28.3 ± 2.9 and 30.9 ± 1.2 cm H 2 O, respectively). Unlike the re-usable Classic LMA and the disposable Marshall laryngeal mask airway, which have silicone cuffs, the disposable Ambu, Intersurgical, Portex Soft Seal and Unique laryngeal mask airways have cuffs constructed from PVC, which seems to be less susceptible to hyperinflation caused by nitrous oxide diffusion.

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Section: Discussionmentioning

confidence: 99%

Nitrous oxide diffusion into the cuffs of disposable laryngeal mask airways

Maino¹,

Dullenkopf²,

Bernet

et al. 2005

Anaesthesia

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“…Compression secondary to cuff overinflation during anaesthesia using nitrous oxide may be a contributing factor. Increasing cuff pressure due to the diffusion of nitrous oxide may result in a stretching and direct pressure to the recurrent laryngeal and the external branch of the superior laryngeal nerve [7,8]. To ensure the appropriate cuff pressure and avoid overinflation a continuous monitoring should be used.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Bilateral Palsy of Terminal Laryngeal and Pharyngeal Branches of the Vagal Nerve

Nauheimer¹,

Doering²,

Breinlich³

et al. 2008

TOATJ

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We report a rare case of a postoperative bilateral laryngeal and pharyngeal lesion of the extracranial vagal nerve following a routine general anaesthesia in prone position. It documents a possible way of a serious complication depending to the positioning of the patient in prone position. Etiological factors and measures to avoid this rare but critical complication are discussed.For the clinical practise it should give an advice to minimize the risk of injuries by malpositioning.Keywords: Prone position, malpositioning, complications, vagal nerve lesion, general anaesthesia. CASEPerioperative complications such as nerve lesions secondary to malpositioning may lead to severe functional disability of the patient and reduce a successful surgical procedure. These regrettable injuries that result from stretching, retraction and/or compression to soft tissue and peripheral nerves are especially true for surgery in prone position [1,2]. We present this rare case of a postoperative bilateral lesion of the extracranial vagal nerve following a routine general anaesthesia in prone position to demonstrate possible ways in which nerves can be damaged in the perioperative phase.A 56 year old, 62 kg weighted woman with a 2 year history of frequent lower back pain presented increasing pain and hypaesthesia of both lower extremities as well as a dyfunction of the urinary bladder for the last 2 months. Radiological imaging showed the lumbal stenosis of L3/4 and L4/5 and the instable degenerative lumbal spondylodesis of L3-5. The neurological deficits indicated neurosurgical decompression of lumbal stenosis and transpedicular stabilization of the lumbal spondylodesis. At admission to the surgical treatment the patient was in good physiological condition. 4 years ago a chronic lymphatic leukaemia (CLL) was detected. The Bcell CLL was diagnosed in an early stage (smoldering Binet A) and was not treated with systemic chemotherapy. She presented a peripheral leucocyte count of 28,000 per μl, 158,000 thrombocytes per μl and a hemoglobine count of 12,2 g/l. Different surgical procedures such as hysterectomy, and total endoprothesis of the right knee joint secondary to gonarthrosis were performed in the past years without significant complications.We introduced general anaesthesia with 20 μg of Sufentanil, 80 mg of Propofol and 30 mg of Rocuronium. The orotracheal intubation proved to be uncomplicated. The orotracheal *Address correspondence to this author at the Department of Anesthesiology and Intensive Care, Hospital of Ludwigsburg, Posilipostr. 4, D-71640 Ludwigsburg, Germany; E-mail: nauhdi01@kliniken-lb.de tubus measured an internal diameter of 7,0 mm and was fixed on the left side of the mouth. The cuff was inflated with air up to 22 cmH 2 O and cuff pressure was monitored continuously using a manometer connected to the cuff pilot balloon. Anaesthesia was maintained with Isoflurane (0,6-0,7 vol.% in exspiration), air-oxygen-inflation with an oxygen-fraction of 100% before and 50% performed in low flow after positioning ...

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“…Of these, 13 were reported with the cLMA and its variants [5][6][7][8][9][10][11][12][13][14][15][16], two with the ProSeal LMA TM [17,18] and one with the Air-Q TM LMA [19] (Table 1).…”

Section: Recurrent Laryngeal Nerve Damagementioning

confidence: 99%

Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series

2014

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SummaryCranial nerve injuries are unusual complications of supraglottic airway use. Branches of the trigeminal, glossopharyngeal, vagus and the hypoglossal nerve may all be injured. We performed a systematic review of published case reports and case series of cranial nerve injury from the use of supraglottic airway devices. Lingual nerve injury was the most commonly reported (22 patients), followed by recurrent laryngeal (17 patients), hypoglossal (11 patients), glossopharyngeal (three patients), inferior alveolar (two patients) and infra-orbital (one patient). Injury is generally thought to result from pressure neuropraxia. Contributing factors may include: an inappropriate size or misplacement of the device; patient position; overinflation of the device cuff; and poor technique. Injuries other than to the recurrent laryngeal nerve are usually mild and self-limiting. Understanding the diverse presentation of cranial nerve injuries helps to distinguish them from other complications and assists in their management.

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Vocal fold palsy after use of the laryngeal mask airway

Cited by 40 publications

References 9 publications

Nitrous oxide diffusion into the cuffs of disposable laryngeal mask airways

Nitrous oxide diffusion into the cuffs of disposable laryngeal mask airways

Postoperative Bilateral Palsy of Terminal Laryngeal and Pharyngeal Branches of the Vagal Nerve

Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series

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