Laryngeal edema associated with the ProSeal laryngeal mask airway in upper respiratory tract infection.
OBJECTIVE
We report an unusual case of vocal cord edema associated with the use of a ProSeal laryngeal mask airway (PLMA) in an adult patient with an undiagnosed upper respiratory tract infection (URTI).


METHODS
A 55-yr-old woman had fixation of a radial fracture under general anesthesia with muscle relaxation. She developed audible wheezing 30 min after PLMA insertion. Bronchoscopic examination revealed significant vocal cord edema. Adequate ventilation was possible at increased airway pressures, and the administration of dexamethasone 4 mg iv produced clinical resolution of the stridor and airway obstruction. The patient admitted to having mild symptoms of an URTI on postoperative questioning.


CONCLUSIONS
Airway hyperreactivity secondary to the URTI is the most likely etiological factor; other possibilities include trauma from insertion and chemical irritation. Although pediatric studies suggest that the LMA-Classic carries less risk than endotracheal intubation in the presence of URTI, this case report demonstrates that caution is still warranted when using supraglottic airways. The PLMA permitted effective ventilation despite increased airway resistance; nevertheless its role in patients with URTI is unclear. It is possible that the bulkier cuff design of the PLMA, compared to that of the LMA-Classic, may have partly contributed to the development of edema in this setting.
Department of Anesthesiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Republic of Singapore. gasgenie@yahoo.co.uk
Ki Jinn
KJ
Chin
Victor W T
VW
Chee
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D003907:Dexamethasone / Q000627:therapeutic use; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007819:Laryngeal Edema / Q000188:drug therapy / Q000209:etiology*; D017214:Laryngeal Masks / Q000009:adverse effects*; D008875:Middle Aged; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000150:complications*
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone