title: Severe bronchospasm during laryngeal mask airway placement in an infant.
abstract: A 35-day-old male infant was scheduled for bilateral inguinal herniorrhaphy. No history of recent upper airway infection or other reactive respiratory disease was noted before anesthesia. Breath holding was noted immediately after laryngeal mask airway (LMA) insertion. Removal of the LMA and positive pressure ventilation via face mask did not solve the problem. On suspicion of laryngospasm, tracheal intubation facilitated by muscule relaxant was performed. However, when the patient was ventilated, high airway pressure, absence of chest wall movement and elevated end-tidal CO2 were noted. Despite visual confirmation of correct placement of tracheal tube, oxygen desaturation and bradycardia developed rapidly. After deepening the inhalational anesthesia of sevoflurane and concomitant administration of intravenous lidocaine, the patient's respiratory condition turned for the better and became compliable. Respiratory dysfunction may be caused by severe bronchospasm induced by placement of the LMA. The pathophysiology and risk factors of bronchospasm related to the LMA placement are discussed in the text.
authors.affiliation: Department of Anesthesiology, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC. tongying@mail.ncku.edu.tw
authors.forename: Tung-Ying
authors.initials: TY
authors.lastname: Tsai
authors.forename: Pei-Jung
authors.initials: PJ
authors.lastname: Chang
authors.forename: Shih-Hsuan
authors.initials: SH
authors.lastname: Chen
authors.forename: Yen-Chin
authors.initials: YC
authors.lastname: Liu
authors.forename: Yen-Hui
authors.initials: YH
authors.lastname: Sung
authors.forename: Yu-Chuan
authors.initials: YC
authors.lastname: Tsai
mesh_terms: D001986:Bronchial Spasm / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male