Abstract
Purpose
To describe a case of intraoperative passive regurgitation where the ProSeal™ laryngeal mask airway (PLMA) successfully protected the airway from the respiratory tract.
Clinical features
A 32-yr-old man was electively scheduled for change of dressings and application of plaster of Paris to both legs. A size 5 PLMA was inserted on the first attempt and the patient allowed to breathe spontaneously. Twenty-five minutes into the procedure brown fluid was noticed in the drainage tube of the mask. There was no change in respiratory pattern nor any evidence of coughing retching or vomiting. Twenty-five millilitres of fluid were suctioned out of the tube which tested positive for acid. The PLMA was left in place and the procedure continued uneventfully. After removal of the mask pH testing showed the dorsum of the mask to have a pH of 7 and the ventrum/bowl of the mask to be dry with a pH of 7. The patient had no respiratory symptoms in the recovery room and the postoperative course was uneventful.
Conclusions
This case illustrates that passive regurgitation can occur unexpectedly intraoperatively and shows that the PLMA can protect the airway during such an event by allowing the regurgitated fluid to pass up the drainage tube without leaking into the glottis.
Résumé
Objectif
Décrire un cas de régurgitation peropératoire passive où le masque laryngé ProSeal™ (MLP) a permis de protéger efficacement les voies aériennes du contenu gastrique.
Éléments cliniques
Le changement des pansements et l’application de plâtre de Paris aux deux jambes avaient été planifiés pour un homme de 32 ans. Un MLP 5 a été inséré au premier essai et le patient a pu respirer spontanément. Vingtcinq minutes après le début de l’intervention, un liquide brunâtre a été noté dans le tube de drainage du masque. La respiration n’était pas affectée et aucune évidence de hautle-cœur ou de vomissement n’était observée. Vingtcinq millilitres de liquide ont été aspirés du tube et une analyse en a révélé un contenu acide. Le MLP a été laissé en place et l’intervention s’est poursuivie sans incident. Après le retrait du masque, un test de pH a montré que le bord dorsal du masque présentait un pH de 7 et la partie ventrale/creuse était sèche et avait un pH de 7. À la salle de réveil, le patient n’avait pas de symptômes respiratoires et la récupération s’est déroulée normalement.
Conclusion
Ce cas illustre le fait qu’une régurgitation passive puisse se produire de façon inattendue pendant une intervention et que le MLP peut alors protéger les voies aériennes en permettant au liquide régurgité de passer dans le tube de drainage sans aller dans la glotte.
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Evans, N.R., Llewellyn, R.L., Gardner, S.V. et al. Aspiration prevented by the ProSeal™ laryngeal mask airway: a case report. Can J Anesth 49, 413–416 (2002). https://doi.org/10.1007/BF03017332
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DOI: https://doi.org/10.1007/BF03017332