Related Experiment Video
Updated: Jun 28, 2026
05:39
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
[Sudden vocal cord closure during general anesthesia using remifentanil]
1Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8501.
Masui. the Japanese Journal of Anesthesiology
|November 4, 2008
Summary
Difficult ventilation during anesthesia can occur with ProSeal laryngeal masks. Opioid use, particularly remifentanil, may cause vocal cord closure, leading to airway obstruction.
Area of Science:
- Anesthesiology
- Respiratory Medicine
- Pharmacology
Background:
- General anesthesia using remifentanil and sevoflurane is common.
- Proseal laryngeal mask airway (LMA) is a widely used supraglottic airway device.
- Ventilatory challenges can arise during anesthesia, necessitating prompt identification of causes.
Observation:
- Three cases of ventilatory difficulty with ProSeal LMA during remifentanil-sevoflurane anesthesia were observed.
- Increased airway pressure was a sudden, critical event in all cases.
- Fiberoptic bronchoscopy in one case revealed vocal cord closure as the cause of obstruction.
Findings:
- Remifentanil administration, combined with sevoflurane and without muscle relaxants, was associated with vocal cord closure.
- This glottic level obstruction led to significant ventilatory difficulty.
- Ventilation was restored upon administration of muscle relaxants like suxamethonium.
Implications:
- Supraglottic airway devices, including ProSeal LMA, require cautious use with remifentanil and sevoflurane when muscle relaxants are omitted.
- Anesthesiologists should consider vocal cord closure as a potential cause of difficult ventilation in this specific anesthetic context.
- Further research into the mechanisms of opioid-induced airway obstruction is warranted.
Related Concept Videos
01:24General Anesthesia: Overview
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:22Stages of General Anesthesia
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:20Inhalational Anesthetics: Overview
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway interventions are...