Use of the Laryngeal Mask Before Tracheal Intubation in a Patient with a Cancerous Nose

Abstract

To the Editor: We report a new indication for the laryngeal mask airway. A 61-year-old man (weight 60 kg) with adenocarcinoma of the nose was scheduled for resection of the tumor and skin flap to the region. The tumor had penetrated the nose skin and was prone to bleeding if pressure was applied. Surgeons requested us not to apply a face mask during the induction of anesthesia to avoid spreading of cancerous exudate to the airway. Preoperatively, there were no pathological changes to the oropharynx. No difficulty in tracheal intubation or in insertion of the laryngeal mask was predicted. In the operating room, while oxygen was given by "open drop" method, lidocaine 50 mg was injected IV. Anesthesia was induced by propofol 3.3 mg/kg and maintained by continuous infusion of propofol, starting with the rate of 10 mg [middle dot] kg (-1) [middle dot] h-1. Immediately after the induction of anesthesia, thrusting the jaw forward did not cause body movements, indicating that the depth of anesthesia was adequate for insertion of the laryngeal mask [1]. The laryngeal mask was inserted without difficulty. While adequate ventilation via the laryngeal mask was being obtained, vecuronium 8 mg was given. A few minutes later, the mask was removed, and the trachea was intubated using a laryngoscope. During this procedure, arterial oxygen hemoglobin saturation remained >98%, and there was no bleeding from the lesion. Both anesthesia and operation proceeded uneventfully. It is possible to insert the laryngeal mask without airway complications immediately after the induction of anesthesia using propofol [1,2]; thus, interruption of ventilation of the lungs is usually <1 min. Therefore, if application of a face mask is undesirable during the induction of anesthesia-for example, in a patient with pathological changes to the tissues around the mouth-the laryngeal mask allows adequate ventilation until a muscle relaxant takes its effect and the trachea is intubated. Takashi Asai, MD, PhD Sachiko Johmura, MD Koh Shingu, MD Department of Anesthesiology; Kansai Medical University; Moriguchi City, Osaka 570-8507, Japan