Mechanical airway obstruction from the laryngeal mask airway cuff

The laryngeal mask airway (LMA) classic has been found useful in airway management of both routine and emergency unexpected failed intubations. We report a case of mechanical airway obstruction from anterior in folding of the laryngeal mask airway classical cuff.

The anaesthetic record of a 55-year-old 70 kg female patient fora left sided total hip replacement that had a failed spinal and was augmented with the laryngeal mask airway.

Near complete airway obstruction developed after the size 4 laryngeal mask airway classic was inserted and the cuff inflated with 30 ml of air. The reduced reservoir volume and the desaturation that ensued as detected by the portable handheld pulse oximeter alerted the anesthesiologist and called for a check which was not corrected by any head and neck manoeuvre. On withdrawal of the laryngeal mask airway, the cuff was noted to have folded unto the fresh gas aperture thereby obstructing ventilation and oxygenation of the patient.

Monitoring the monitors and quick reassessment of laryngeal cuff placement guaranties the evasion of anaesethetic catastrophes.