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LETTER TO EDITOR
Year : 2011  |  Volume : 55  |  Issue : 5  |  Page : 542  

Laryngeal mask airway classic as a rescue device after accidental extubation in a neonate in prone position


Department of Anesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India

Date of Web Publication14-Nov-2011

Correspondence Address:
Ajith Gopinath
Department of Anesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.89902

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How to cite this article:
Taxak S, Gopinath A. Laryngeal mask airway classic as a rescue device after accidental extubation in a neonate in prone position. Indian J Anaesth 2011;55:542

How to cite this URL:
Taxak S, Gopinath A. Laryngeal mask airway classic as a rescue device after accidental extubation in a neonate in prone position. Indian J Anaesth [serial online] 2011 [cited 2021 Apr 19];55:542. Available from: https://www.ijaweb.org/text.asp?2011/55/5/542/89902

Sir,

We report a case of accidental extubation in a neonate who underwent surgery in prone position, and subsequent airway management with an Laryngeal mask airway (LMA) classic, in the same position.

A 6-day-old male child, weighing 2.65 kg was posted for surgical repair of meningomyelocele. After induction of anaesthesia, and adequate muscle relaxation, the trachea was intubated with an uncuffed tube of 3-mm internal diameter. The tube was connected to the paediatric circuit and positive pressure ventilation instituted. After checking for proper placement and adequate ventilation, the tracheal tube was secured with a fixation tape. The child was turned prone for the surgery, with the head turned towards his left side. About 20 minutes after the surgery had commenced, inadequate ventilation of lungs was noticed, as evidenced by the feel of the bag, and disappearance of the end-tidal CO 2 graph. The tracheal tube had slipped out and the tip was found to be in the oral cavity, which probably occurred due to wetting of fixation tape by saliva, and subsequent tube displacement. The tube was removed, and a size 1 LMA Classic was inserted with the cuff partially deflated, in the first attempt. After inflating the cuff, the airway tube was connected to the breathing circuit and positive pressure ventilation reinstituted. The ventilation was adequate, as evidenced by equal bilateral air entry and the capnograph trace on the monitor. The O 2 saturation was 100% during the sequence of events. The surgery was completed in another 15 minutes, during which the haemodynamic and respiratory parameters were normal. The child was turned supine, and neuromuscular blockade was reversed when he was conscious. The LMA was removed, following which, gentle oral suction was done. The postoperative period was uneventful.

Another way of managing this complication would have been turning the child supine, and reintubating the trachea. But turning the patient supine and managing the patient would mean a little longer time without a definite airway and ventilation in an anaesthetized, paralyzed neonate. In addition, the risk of spinal cord injury and compromising the surgical field sterility in this case during such manipulation made us consider securing airway in the prone position. Moreover, we had a size 1 LMA Classic ready on the anaesthesia cart and the authors are experienced in the use of various supraglottic airway devices in the prone position in adult patients. [1] Several authors have reported management of accidental extubation in prone position with LMA Classic. [2],[3] To the best of our knowledge, this is the first report of such an instance in a neonate.

 
   References Top

1.Taxak S, Gopinath A. Insertion of the i-gel airway in prone position. Minerva Anestesiol 2010;76:381.  Back to cited text no. 1
[PUBMED]    
2.Dingeman RS, Goumnerova LC, Goobie SM. The use of a laryngeal mask airway for emergent airway management in a prone child. Anesth Analg 2005;100:670-1.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Raphael J, Rosenthal-Ganon T, Gozal Y. Emergency airway management with a laryngeal mask airway in a patient placed in the prone position. J Clin Anesth 2004;16:560-1.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  



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