Abstract
BackgroundLaryngeal mask airway (LMA) insertion contributes to airway protection in patients with a laryngeal tumor around the glottis. There has been no report of LMA insertion itself exacerbating airway obstruction in such patients.Case presentationA 62-year-old male underwent elective surgical resection of a large laryngeal polyp. The polyp was attached to the right vocal fold and synchronously swung inward into the trachea and outward to the larynx with inspiration and expiration, respectively. Although manual positive pressure ventilation was easily achieved without any airway obstruction after anesthetic induction, the airway was completely obstructed by the polyp lodged between the vocal cords immediately after LMA insertion. Soon after removal of the LMA, patency of the airway was dramatically improved.ConclusionOur experience indicates that we should pay attention to airway obstruction due to lodging of the polyp between the vocal cords after LMA insertion in patients with a laryngeal polyp.
Highlights
Laryngeal mask airway (LMA) insertion contributes to airway protection in patients with a laryngeal tumor around the glottis
Endotracheal intubation using a thin endotracheal tube (ETT), and high-frequency jet ventilation have been used for airway management for laryngoscopic surgery with a rigid laryngoscope in such patients [1]
Another option is a laryngeal mask airway (LMA), which has been used for airway protection, and introduction of a flexible laryngoscope for surgery has been successfully used in such patients [2]
Summary
Surgery and anesthetic management of patients with a laryngeal tumor occupying the space of the glottis is challenging for anesthesiologists because airway obstruction can occur during surgery. Endotracheal intubation using a thin endotracheal tube (ETT), and high-frequency jet ventilation have been used for airway management for laryngoscopic surgery with a rigid laryngoscope in such patients [1]. Another option is a laryngeal mask airway (LMA), which has been used for airway protection, and introduction of a flexible laryngoscope for surgery has been successfully used in such patients [2]. We report a patient with a laryngeal polyp in whom manual positive pressure ventilation was achieved after anesthetic induction, but the airway was completely obstructed by the polyp lodged between the vocal cords following LMA insertion. SpO2 was 97% on Fuseya et al JA Clinical Reports (2018) 4:43
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