Cuff herniation with laryngeal mask airway

ABSTRACT

The laryngeal mask airway [LMA] is being widely used for securing the airway in patients undergoing elective surface surgery under general anesthesia. However, use of LMA may involve some medical problems associated with its technical performance as an airway device. We encountered an unusual and potentially serious problem. A 47-year-old, female patient diagnosed as breast cancer underwent wide local excision and sentinel lymph node biopsy under general anesthesia. After induction of anesthesia, a size 4 reusable classic LMA was inserted and the cuff was inflated with 40 ml of air. A few moments after insertion of the LMA, an audible leak was noted. The cuff was inflated with a further 5 ml of air. The audible leak decreased, but did not disappear completely. Anesthesia was maintained but after 20 minutes the audible leak increased and ventilation became difficult. The LMA was removed and another LMA size 4 was inserted again. At the end of the procedure the patient was allowed to recover and the LMA was removed. After 45 minutes patient was discharged from recovery room. An examination of the device showed that there was a LMA cuff herniation