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Departments of Anesthesiology, Perioperative and Pain Medicine and Neurosurgery; Childrens Hospital Boston, Harvard Medical School, Boston, Massachusetts
Address correspondence and reprint requests to R. Scott Dingeman, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Childrens Hospital, 300 Longwood Ave., Boston, MA 02115. Address e-mail to scott{at}dingeman.com.
A 5-yr-old girl with Arnold-Chiari Malformation, Type 1, was accidentally tracheally extubated while positioned prone in a Mayfield neurosurgical headrest during a decompressive craniectomy and cervical laminectomy. While preparations were being made to return the patient to the supine position for reintubation, we placed a laryngeal mask airway (LMA) without difficulty. The child was kept in the prone position with the LMA in place using positive-pressure ventilation for the remainder of the operation. This case report emphasizes the practical, emergent use of a LMA to secure the airway of a pediatric patient in the prone position after accidental extubation.
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