Transient vocal cord deformity caused by a laryngeal mask airway device during flexible fibreoptic bronchoscopy

Abstract

To the Editor, Both anesthesiologists and respirologists commonly perform flexible fibreoptic bronchoscopy. At our institution, an anesthesiologist attends all flexible bronchoscopies that involve endobronchial ultrasound (EBUS), and a laryngeal mask airway device is generally employed for airway protection and introduction of the flexible scope. The use of laryngeal mask airway devices for flexible bronchoscopy is well established as it allows an unobstructed view of the larynx and access to the lower respiratory tract while maintaining airway control. A 75-yr-old female with significant smoking history and a solitary pulmonary nodule presented for diagnostic bronchoscopy and EBUS. The patient’s medical history was otherwise notable for a laparoscopic sigmoid colon resection one month prior. Her airway was topicalized with 2-4% lidocaine via gargle and an atomizing device, and sedation was achieved with propofol and remifentanil infusions. A size 3.5 air-Q laryngeal mask airway device (Cookgas, Saint Louis, MO, USA) was placed without difficulty. During introduction of the flexible bronchoscope, we noted a significant abnormality of the patient’s left vocal cord and mild bowing of the right (Fig. 1). Our initial suspicion of laryngeal trauma related to the patient’s recent anesthetic was disproven when a minor adjustment of the laryngeal mask airway device resolved the deformity (Fig. 2). Normal vocal cord apposition during phonation was subsequently documented, and the patient did not suffer from hoarseness or other dysphonia following the procedure. Although laryngeal mask airway devices are designed to seat within the hypopharynx, Brimacombe and Berry have pointed out that we lack a detailed understanding of their mechanical impact on pharyngeal structures. A review of the literature suggests that the overall anatomic