Abstract
Background: The LMA® Protector™ Airway is a new supraglottic airway device with Cuff Pilot™ Technology that enables visual monitoring of intra-cuff pressure, to reduce the risk of complications from an overinflated device. Case: We present a case of unilateral hypoglossal nerve injury after its use. In our knowledge, this is the first reported case of hypoglossal nerve injury after LMA® Protector™ use. Learning Points: Hypoglossal nerve injury is a rare but distressing complication of LMA use. The greater horn of the hyoid bone is a potential site of injury, as the cuff of the LMA may compress the nerve against bone. In our patient, possible contributing factors included cuff overinflation with/without failure of the Cuff Pilot™ technology, inappropriate sizing and placement of an unfamiliar device. Fortuitously, injury is often neuropraxia with complete recovery in 6 months following conservative management. Consideration should be given to down-sizing the device for Asian patients who tend to have smaller jaws for their weight range. We caution that whilst the green zone of the Cuff Pilot™ corresponds to 40 - 60 cm H2O cuff pressure, it may be more than the “just-seal” pressure required and the cuff may still be overinflated relative to the size of the patient’s airway.
Highlights
The laryngeal mask airways (LMAs)® ProtectorTM Airway is currently the newest second generation supraglottic airway device (SAD) from the inventors of laryngeal mask
We present the first case of a unilateral hypoglossal nerve palsy after the use of the LMA® ProtectorTM Airway
Complications from the usage of Supraglottic Airway Devices are largely defined by minor pharyngolaryngeal complications such as: sore throat (17% - 42% of patients); soft tissue abrasion (16% - 32%); hoarseness and dysphagia
Summary
The LMA® ProtectorTM Airway is currently the newest second generation supraglottic airway device (SAD) from the inventors of laryngeal mask What makes the LMA® ProtectorTM Airway unique is its integrated Cuff PilotTM Technology—a cuff pressure indicator that enables continuous cuff pressure monitoring through visual means, to facilitate easy and accurate adjustments and reduce the risk of complications from an overinflated device [4] [5]. Nerve injuries such as recurrent laryngeal nerve palsy, lingual nerve palsy and hypoglossal nerve palsy have been reported with the use of laryngeal mask airways (LMAs), caused by overinflation of the cuff or high cuff pressures on the surrounding structures [6]. We present the first case of a unilateral hypoglossal nerve palsy after the use of the LMA® ProtectorTM Airway
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