Use of the Laryngeal Mask During Emergence from Anesthesia in a Patient with an Unstable Neck

Abstract

To the Editor: Stimulatory effects of the presence of a tracheal tube during emergence from anesthesia can be minimized by extubating the trachea while the patient is still anesthetized. However, supraglottic airway obstruction may occur after extubation, making it necessary to maneuver the head and neck [1,2]. We report a unique use of the laryngeal mask during emergence from anesthesia in a patient whose head and neck were stabilized and in whom stress responses associated with tracheal extubation could be detrimental. A 35-yr-old man with cervical hernia underwent anterior laminectomy. An iliac bone was implanted to stabilize the cervical bone. At the end of operation, surgeons requested us to minimize straining (bucking), coughing, or maneuvering the patient's head and neck during emergence from anesthesia, because an implanted bone might dislodge. While the patient was still anesthetized, the head and neck were stabilized by the manual in-line method, and the laryngeal mask was inserted with little difficulty while a tracheal tube was still in place. The tracheal tube was then removed, and the cuff of the laryngeal mask was inflated. Adequate ventilation was confirmed, and inhaled anesthetics were discontinued. After the patient had regained consciousness and responded to verbal command, the laryngeal mask was removed. No respiratory complication, such as straining, coughing, or laryngospasm, occurred during emergence from anesthesia. Insertion of the laryngeal mask after tracheal extubation has been reported [3,4]. However, in the patient whose neck is stabilized, insertion of the laryngeal mask may be difficult [5], and if insertion has failed after extubation, maneuvering of the head and neck may be required to obtain a patent airway; this maneuvering could damage an unstable neck. Insertion of the mask before tracheal extubation minimizes the incidence of airway obstruction [2,6] and may be particularly useful in patients in whom stress responses can be detrimental, such as in patients with an unstable neck. Takashi Asai, MD PhD Koh Shingu, MD Department of Anesthesiology; Kansai Medical University; Moriguchi City, Osaka, Japan