Multiple system atrophy as a cause of upper airway obstruction.
A patient presented to the ear, nose and throat department with inspiratory stridor, dysphagia and a sore throat. Clinical and radiological examination was normal. During induction of anaesthesia for a planned microlaryngoscopy, the patient developed complete upper airway obstruction that was overcome by applying positive pressure via a facepiece until awake. He subsequently developed respiratory failure, requiring mechanical ventilatory support. An elective tracheostomy was inserted for his symptoms. Neurological opinion confirmed the diagnosis of multiple system atrophy with akinetic rigid syndrome. We review this obscure condition and how it may occasionally present to anaesthetists.
Lim
Y S
YS
Visiting Instructor, Department of Anaesthesiology, University of Michigan, 1H247 University Hospital -1500 East Medical Center Drive, Ann Arbor, MI 48109-9091, USA. yen77@rocketmail.com
Kennedy
N J
NJ
D000328:Adult; D000402:Airway Obstruction / Q000209:etiology*; D000769:Anesthesia, Inhalation / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D019578:Multiple System Atrophy / Q000150:complications*; D012135:Respiratory Sounds / Q000209:etiology; D014826:Vocal Cord Paralysis / Q000209:etiology