Abstract
Purpose
To describe negative pressure injury occurring during the use of a laryngeal mask airway (LMA) in which airway bleeding rather than pulmonary oedema was the major complication.
Clinical Features
A patient presented to the day surgery unit for resection of a ganglion cyst on her right wrist. She underwent general anaesthesia using an LMA. and experienced severe laryngospasm and transient hypoxaemia (oxygen saturation to 66%) seven minutes after incision. This resolved within 90 sec of succinylcholine administration. Nonetheless, the LMA was removed, a tracheal tube was inserted atraumatically and positive pressure ventilation was maintained until the time of emergence, when fresh blood appeared in the tracheal tube. The blood ultimately became frothy, resembling pulmonary oedema fluid. Haemoptysis, continued postoperatively and led to the hospitalization of this ambulatory patient.
Conclusion
Rapid development of large subatmosphenc pressures, as can occur dunng severe laryngospasm, may disrupt the tracheobronchial vasculature causing airway bleeding. This bleeding should be distinguished from negative pressure pulmonary oedema.
Résumé
Objectif
Rapporter une lésion causée par la pression négative survenue pendant l’utilisation d’un masque laryngé (ML). La présence de sang au niveau des voies respiratoires provenait d’une hémorragie et non d’un oedème pulmonaire.
Éléments cliniques
Une patiente se présente à l’unité de chirurgie ambulatoire pour la résection d’un kyste au poignet droit. Pendant l’anesthésie générale au masque laryngé, il survient un laryngospasme grave avec hypoxie transitoire (saturation en oxygène à 66%) sept minutes après l’incision. La situation se rétablit à moins de 90 secondes après l’adminsitration de succinylcholine. On retire le ML et on introduit de façon atraumatique une canule endotrachéale. La ventilation mécanique est maintenue jusqu’au réveil alors que du sang frais apparaît dans la canule orotrachéale. Le sang devient plus tard spumeux comme dans le cas d’un oedème pulmonaire. C’est l’hémoptysie continue qui nécessite en postopératoire l’hospitalisation de cette patiente ambulante.
Conclusion
De grandes pressions sous-atmosphériques soudaines, comme au moment d’un laryngospasme important, peuvent traumatiser la trame vasculaire trachéobronchique et provoquer ainsi un saignement des voies aériennes. II faut distinguer ce saignement de l’oedème pulmonaire par pression négative.
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Bhavani-Shankar, K., Hart, N.S. & Mushlin, P.S. Negative pressure induced airway and pulmonary injury. Can J Anesth 44, 78–81 (1997). https://doi.org/10.1007/BF03014328
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DOI: https://doi.org/10.1007/BF03014328