CASE REPORT
Page | 554
Partial airway obstruction following manufacturing defect in laryngeal mask airway (Laryngeal Mask SilkenTM) Kiran Jangra, Surender Kumar Malhotra, Vikas Saini
A B S T R A C T Laryngeal mask (LM) airway is commonly used for securing airway in day‑care surgeries. Various problems have been described while using LM airway. Out of those, mechanical obstruction causing airway compromise is most common. Here, we describe a case report of 4‑year‑old child who had partial upper airway obstruction due to LM manufacturer’s defect. There was a silicon band in upper one‑third of shaft of LM airway. This band was made up of the same material as that of LM airway so it was not identifiable on external inspection of transparent shaft. We suggest that such as non‑transparent laryngeal mask, a transparent LM airway should also be inspected looking inside the lumen with naked eyes or by using a probe to rule out any manufacturing defect before its insertion.
Department of Anesthesia and Intensive Care, Post‑Graduate Institute of Medical Education and Research, Chandigarh, India Address for correspondence: Dr. Kiran Jangra, Department of Anesthesia and Intensive Care, 4th Floor, Nehru Hospital, Post‑Graduate Institute of Medical Education and Research, Chandigarh, India. E‑mail: drkiransharma0117@gmail. com
Key words: Airway, laryngeal mask airway, obstruction
INTRODUCTION Laryngeal mask (LM) airway has been used successfully in day care set‑up and short surgical procedures. Upper airway obstruction can occur secondary to laryngospasm, malpositioning of LM airway, a foreign body obstructing the lumen or folding of epiglottis over laryngeal inlet. There are few case reports describing upper airway obstruction as a result of mechanical obstruction.[1] CASE REPORT
Silken (LM‑Silken, Romsons, Agra, India) was inserted in sniffing position. Although the patient was breathing spontaneously, suprasternal retraction was observed, suggesting partial upper airway obstruction. Since there was no change in EtCO2 it was decided to proceed with surgery. Completion of surgery was uneventful and LM‑Silken was removed in deep plane of anesthesia. Suprasternal retraction disappeared immediately, confirming the intraoperative airway obstruction due to LM‑Silken. On inspection, a silicon band was detected in the upper‑third lumen of LM‑Silken shaft, apparently causing partial airway obstruction [Figure 1].
A 4‑year‑old child was scheduled for congenital cataract surgery under general anesthesia. After attaching standard monitors, inhalation induction was undertaken using the sevoflurane. After securing IV line, injection fentanyl was administered and size‑2 reusable Laryngeal Mask Access this article online Quick Response Code:
Website: www.saudija.org
DOI: 10.4103/1658-354X.140899
Figure 1: Laryngeal mask airway showing silicon band Vol. 8, Issue 4, October-December 2014
Saudi Journal of Anesthesia
Jangra, et al.: Airway obstruction following manufacturing defect in LM Airway
DISCUSSION This band being of the same color and consistency as that of LM‑Silken material was missed on external visual inspection before use. Manufacturer’s defects such as, meniscus or plastic films causing intraluminal obstruction have been earlier described in tracheal tubes.[1,2] Solaidhanasekaran and Bharamgoudar reported a case in which LM airway caused upper airway obstruction secondary to cuff herniation.[3] In another case report, Ungern‑Sternberg and Erb described an upper airway obstruction following the detachment of the cuff weld near the tip of the pediatric LM airway.[4] An external visual inspection of LM airway is routinely recommended to rule out any foreign material in the lumen likely to cause airway obstruction. In our case, since the intraluminal defect was of the same material as that of LM‑Silken, it could not be visualized by external inspection before its use. We suggest that such as non‑transparent
laryngeal mask, a transparent LM airway should also be inspected looking inside the lumen with naked eyes or by using a probe to rule out any manufacturing defect before its insertion. REFERENCES 1. Sofi K, El‑Gammal K. Endotracheal tube defects: Hidden causes of airway obstruction. Saudi J Anaesth 2010;4:108‑10. 2. Hajimohammadi F, Taheri A, Eghtesadi‑Araghi P. Obstruction of endotracheal tube; a manufacturing error. Middle East J Anesthesiol 2009;20:303‑5. 3. Solaidhanasekaran S, Bharamgoudar M. Airway obstruction secondary to herniation of the paediatric laryngeal mask airway. Anesthesia 2008;63:785‑6. 4. von Ungern‑Sternberg BS, Erb TO. Partial airway obstruction by a pediatric laryngeal mask airway. Anesth Analg 2004;99:951. How to cite this article: Jangra K, Malhotra SK, Saini V. Partial airway obstruction following manufacturing defect in laryngeal mask airway (Laryngeal Mask SilkenTM). Saudi J Anaesth 2014;8:554-5. Source of Support: Nil, Conflict of Interest: None declared.
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iPhone App A free application to browse and search the journal’s content is now available for iPhone/iPad. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility. The application is Compatible with iPhone, iPod touch, and iPad and Requires iOS 3.1 or later. The application can be downloaded from http:// itunes.apple.com/us/app/medknow-journals/id458064375?ls=1&mt=8. For suggestions and comments do write back to us.
Saudi Journal of Anesthesia
Vol. 8, Issue 4, October-December 2014
Page | 555
Copyright of Saudi Journal of Anaesthesia is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Page | 554
Partial airway obstruction following manufacturing defect in laryngeal mask airway (Laryngeal Mask SilkenTM) Kiran Jangra, Surender Kumar Malhotra, Vikas Saini
A B S T R A C T Laryngeal mask (LM) airway is commonly used for securing airway in day‑care surgeries. Various problems have been described while using LM airway. Out of those, mechanical obstruction causing airway compromise is most common. Here, we describe a case report of 4‑year‑old child who had partial upper airway obstruction due to LM manufacturer’s defect. There was a silicon band in upper one‑third of shaft of LM airway. This band was made up of the same material as that of LM airway so it was not identifiable on external inspection of transparent shaft. We suggest that such as non‑transparent laryngeal mask, a transparent LM airway should also be inspected looking inside the lumen with naked eyes or by using a probe to rule out any manufacturing defect before its insertion.
Department of Anesthesia and Intensive Care, Post‑Graduate Institute of Medical Education and Research, Chandigarh, India Address for correspondence: Dr. Kiran Jangra, Department of Anesthesia and Intensive Care, 4th Floor, Nehru Hospital, Post‑Graduate Institute of Medical Education and Research, Chandigarh, India. E‑mail: drkiransharma0117@gmail. com
Key words: Airway, laryngeal mask airway, obstruction
INTRODUCTION Laryngeal mask (LM) airway has been used successfully in day care set‑up and short surgical procedures. Upper airway obstruction can occur secondary to laryngospasm, malpositioning of LM airway, a foreign body obstructing the lumen or folding of epiglottis over laryngeal inlet. There are few case reports describing upper airway obstruction as a result of mechanical obstruction.[1] CASE REPORT
Silken (LM‑Silken, Romsons, Agra, India) was inserted in sniffing position. Although the patient was breathing spontaneously, suprasternal retraction was observed, suggesting partial upper airway obstruction. Since there was no change in EtCO2 it was decided to proceed with surgery. Completion of surgery was uneventful and LM‑Silken was removed in deep plane of anesthesia. Suprasternal retraction disappeared immediately, confirming the intraoperative airway obstruction due to LM‑Silken. On inspection, a silicon band was detected in the upper‑third lumen of LM‑Silken shaft, apparently causing partial airway obstruction [Figure 1].
A 4‑year‑old child was scheduled for congenital cataract surgery under general anesthesia. After attaching standard monitors, inhalation induction was undertaken using the sevoflurane. After securing IV line, injection fentanyl was administered and size‑2 reusable Laryngeal Mask Access this article online Quick Response Code:
Website: www.saudija.org
DOI: 10.4103/1658-354X.140899
Figure 1: Laryngeal mask airway showing silicon band Vol. 8, Issue 4, October-December 2014
Saudi Journal of Anesthesia
Jangra, et al.: Airway obstruction following manufacturing defect in LM Airway
DISCUSSION This band being of the same color and consistency as that of LM‑Silken material was missed on external visual inspection before use. Manufacturer’s defects such as, meniscus or plastic films causing intraluminal obstruction have been earlier described in tracheal tubes.[1,2] Solaidhanasekaran and Bharamgoudar reported a case in which LM airway caused upper airway obstruction secondary to cuff herniation.[3] In another case report, Ungern‑Sternberg and Erb described an upper airway obstruction following the detachment of the cuff weld near the tip of the pediatric LM airway.[4] An external visual inspection of LM airway is routinely recommended to rule out any foreign material in the lumen likely to cause airway obstruction. In our case, since the intraluminal defect was of the same material as that of LM‑Silken, it could not be visualized by external inspection before its use. We suggest that such as non‑transparent
laryngeal mask, a transparent LM airway should also be inspected looking inside the lumen with naked eyes or by using a probe to rule out any manufacturing defect before its insertion. REFERENCES 1. Sofi K, El‑Gammal K. Endotracheal tube defects: Hidden causes of airway obstruction. Saudi J Anaesth 2010;4:108‑10. 2. Hajimohammadi F, Taheri A, Eghtesadi‑Araghi P. Obstruction of endotracheal tube; a manufacturing error. Middle East J Anesthesiol 2009;20:303‑5. 3. Solaidhanasekaran S, Bharamgoudar M. Airway obstruction secondary to herniation of the paediatric laryngeal mask airway. Anesthesia 2008;63:785‑6. 4. von Ungern‑Sternberg BS, Erb TO. Partial airway obstruction by a pediatric laryngeal mask airway. Anesth Analg 2004;99:951. How to cite this article: Jangra K, Malhotra SK, Saini V. Partial airway obstruction following manufacturing defect in laryngeal mask airway (Laryngeal Mask SilkenTM). Saudi J Anaesth 2014;8:554-5. Source of Support: Nil, Conflict of Interest: None declared.
Announcement
iPhone App A free application to browse and search the journal’s content is now available for iPhone/iPad. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility. The application is Compatible with iPhone, iPod touch, and iPad and Requires iOS 3.1 or later. The application can be downloaded from http:// itunes.apple.com/us/app/medknow-journals/id458064375?ls=1&mt=8. For suggestions and comments do write back to us.
Saudi Journal of Anesthesia
Vol. 8, Issue 4, October-December 2014
Page | 555
Copyright of Saudi Journal of Anaesthesia is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
