title: [A case report of severe laryngeal edema which occured before removal of a laryngeal mask airway].
abstract: A 41-year-old woman was scheduled for a partial hip arthroplasty. She was suffering from malignant rheumatoid arthritis for a long time and we recognized her difficult airway. After epidural catheterization, anesthesia was induced with fentanyl, thiopental, and 5% sevoflurane with oxygen. A laryngeal mask airway (LMA ; size 3) was inserted smoothly on third trial after suxamethonium chloride administration. Anesthesia was maintained with fentanyl, vecuronium bromide, sevoflurane with oxygen and epidural anesthesia. No complications were observed during the operation. After reversal of muscle relaxant, spontaneous respiration returned. But inspiratory stridor and chest wall retraction occurred soon, and we found severe epiglottic edema by bronchoscopy. A tracheal tube (ID 5.5 mm) was intubated immediately through the LMA. Twenty hours later the pharyngeal edema was still very severe, and tracheotomy was performed. The edema disappeared three days later. We thought the edema had occurred as a result of blood flow disturbance caused by LMA in narrow pharyngeal space expanding to the epiglottis. It should be kept in mind that severe edema could develop after LMA in malignant rheumatoid arthritis.
authors.affiliation: Department of Anesthesiology, Kin-Ikyo Chuo Hospital, Sapporo 007-8505.
authors.forename: Izumi
authors.initials: I
authors.lastname: Hayashi
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Komeichi
authors.forename: Naoki
authors.initials: N
authors.lastname: Morinaga
authors.forename: Hiromi
authors.initials: H
authors.lastname: Mizoguchi
authors.forename: Ryohei
authors.initials: R
authors.lastname: Takakuwa
authors.forename: Mikihito
authors.initials: M
authors.lastname: Fujiwara
mesh_terms: D001172:Arthritis, Rheumatoid / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D007819:Laryngeal Edema / Q000209:etiology* / Q000601:surgery; D017214:Laryngeal Masks / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D014140:Tracheotomy; D016896:Treatment Outcome