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LETTER TO THE EDITOR

Laryngeal Mask Airway and Tonsillectomy

Department of Anesthesia; Belfast City Hospital; Belfast, United Kingdom; s_enthil{at}yahoo.com

To the Editor:

The following case report documents a potentially serious complication of laryngeal mask (LMA) use. A healthy 19-yr-old woman was scheduled for tonsillectomy. We controlled her airway with a Size 4 LMA. The patient breathed spontaneously. However, the airway became totally obstructed, coincident with the removal of the first tonsil. Visual inspection demonstrated that the pilot tubing was severed by the snare used to remove the tonsil, deflating the cuff. The LMA was replaced without incident.

Studies have suggested that advantages for using a LMA during adenotonsillectomy, including good surgical access without increasing the risk of aspiration (1), decreased anesthetic depth, and no requirement for neuromuscular blockade (2). Complications include laryngeal spasm and airway obstruction from the throat gag (3,4). To this list, we can also add the surgeon's inadvertently cutting the LMA pilot tube.

REFERENCES

1. Williams PJ, Bailey PM. Comparison of the reinforced laryngeal mask airway and tracheal intubation of adeno-tonsillectomy. Br J Anaesth 1993;70:30–3.[Abstract/Free Full Text]
2. Sanchez GS, Garcia IMT, Abrante JA, et al. Acta Otorrinolaringol Esp 1998;49:389–96.[Medline]
3. Webster AC, Morley-Forster PK, Dain S, et al. Anesthesia for adenotonsillectomy: a comparison between tracheal intubation and the laryngeal mask airway. Can J Anaesth 1993;40:1171–7.[Web of Science][Medline]
4. Heath ML, Sinnathamby SW. The reinforced laryngeal mask airway for adenotonsillectomy. Br J Anaesth 1994;72:728, 729.

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