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LETTER TO EDITOR
Year : 2014  |  Volume : 58  |  Issue : 1  |  Page : 97-98  

Acute sialadenitis of parotid gland: Anaesthesia mumps


1 Department of Anaesthesiology, Balaji Institute of Surgery, Research and Rehabilitation for the Disabled, Tirumala Tirupati Devasthanams, Tirupati, Andhra Pradesh, India
2 Department of Orthopaedics, Balaji Institute of Surgery, Research and Rehabilitation for the Disabled, Tirumala Tirupati Devasthanams, Tirupati, Andhra Pradesh, India

Date of Web Publication13-Feb-2014

Correspondence Address:
Koramutla Pradeep Kumar
Department of Anaesthesiology, Balaji Institute of Surgery, Research and Rehabilitation for the Disability Hospital, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.126852

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How to cite this article:
Kumar KP, Kumar P K, Jagadesh G. Acute sialadenitis of parotid gland: Anaesthesia mumps. Indian J Anaesth 2014;58:97-8

How to cite this URL:
Kumar KP, Kumar P K, Jagadesh G. Acute sialadenitis of parotid gland: Anaesthesia mumps. Indian J Anaesth [serial online] 2014 [cited 2020 Dec 4];58:97-8. Available from: https://www.ijaweb.org/text.asp?2014/58/1/97/126852

Sir,

Acute swelling of the parotid gland, a very rare complication observed after general anaesthesia during the peri-operative period was first reported by Attas et al. [1] later named as 'Anaesthesia mumps' [2] and which regresses without any medications. [1],[2],[3],[4] We report acute sialadenitis of the right parotid gland after surgery for spondylolisthesis in prone position.

A 54-year-old obese (body mass index = 30.8 kg/m 2 ) lady diagnosed with spondylolisthesis on magnetic resonance imaging was advised spinal fusion surgery of L2-L3, L4-L5 under general anaesthesia. She had hypertension and hypothyroidism both of which were under control. Her pre-operative haemoglobin was 10 g%. Patient was premedicated with Alprazolam 0.5 mg orally on the day before surgery. In the operating room, intravenous access with 18G cannula was secured and standard monitoring included electrocardiogram, non-invasive blood pressure, end tidal concentration of carbon-dioxide and pulse oximetry. Induction was achieved with thiopentone sodium 4-5 mg/kg of 2.5% solution, titrated to loss of eye lash reflex. Analgesia was provided with fentanyl 2 mickg−1 . Endotracheal intubation was facilitated by using vecuronium bromide as muscle relaxant (0.1 mg / kg) and anaesthesia was maintained with sevoflurane (1%) with N 2 O:O 2 (66:33). Endotracheal tube was fixed to the right without any pressure on the cheeks and was plastered without any pressure. Mechanical ventilation was started with volume controlled ventilation using, tidal volume of 8 ml/kg and respiratory rate of 12/min. Patient was positioned in prone position with adequate padding of eyes and also supporting with the bolsters under the chest and hips. The head was in neutral position (parallel to the heart) and was not changed intra-operatively. Head rest was made of foam with a central hemicircle opening and a small passage for the endotracheal tube to the right side. Intra-operatively, muscle relaxation was provided using neuromuscular monitoring and depth of anaesthesia was monitored by Bispectral index, intravenous fluids using crystalloids and colloids given and urine output maintained at 0.5-1 ml/kg/h. Intra-operative mean arterial blood pressure was maintained at 70-80 mmHg. Patient did not require inotropes or vasopressors. Total duration of surgery was 5 h and the blood loss was 600 ml. In view of post-operative bleeding and for proper wound healing, blood was transfused. After surgery patient was turned supine and extubated after reversal of residual neuromuscular blockade with injection neostigmine 0.05 mg/kg and glycopyrrolate 0.01 mg/kg. In the post-operative period after 6 h a bilateral swelling of the parotid gland in the pre-auricular and post-auricular region was noted extending to the angle of mandible. Swelling was more on the right side of the face lifting the auricle [Figure 1] with no signs of inflammation; skin over the swelling was soft without any local rise of temperature and was painless. The patient was reassured, administered 1 g of intravenous methyl prednisolone. Suspecting renal abnormality, renal function tests and electrolytes were ordered and were normal. The swelling spontaneously regressed after 48 h.
Figure 1: Parotid gland enlargement on the right side

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Anaesthesia mumps can occur due to mechanical trauma during endotracheal intubation i.e. trauma to the laryngeal structures, causing bleeding and post-operative oedema; drugs (antihistaminics, succinyl choline and atropine); systemic dehydration causing stagnation in stensons duct or obstruction due to stagnation of secretions or by calculi. [2],[5],[6] In our patient, there was no difficulty in intubating the patient, patients' hydration was maintained and none of the above mentioned drugs were given. Other cause implicated is ischaemic sialadenitis which can result due to the position of the patient resulting in compression of the arterial and venous blood vessels of the parotid gland as a result of ischemia-reperfusion manifesting in the intra-operative period and immediate post-operative period respectively [7] causing a painful swelling with haemorrhagic spots. In our case, the swelling was painless with absence of haemorrhagic spots. There can be association with hypothyroidism. [8] However, relevant investigations were normal and no swelling was noticed. Another cause can be pneumoparotitis, due to retrograde flow of air into the stensons duct orifice due to cough or straining during the anaesthetic procedure [2] seen as crepitations over the swelling. No crepitations were present and hence, this was also ruled out. Position of the patient is the most important factor known to cause it and has been reported in sitting position, [3] head extension [4] and also in the prone position. [9] In our case, the cause for the swelling was probably due to partial compression of the parotid gland in prone position. The long duration of surgery, tight fixation of the endotracheal tube with adhesive plaster in an obese patient could be the other possibilities.

Though a benign condition it can be potentially life-threatening. [7] We report this case to increase its awareness and to highlight its importance since it can cause unnecessary apprehension to the patient, the surgeon and the anaesthesiologist. Hence, we recommend that in patients who undergo long duration surgery as was in our case, proper care with respect to positioning, good oral hygiene and smooth extubation should be taken.

 
   References Top

1.Attas M, Sabawala PB, Keats AS. Acute transient sialadenopathy during induction of anesthesia. Anesthesiology 1968;29:1050-2.  Back to cited text no. 1
[PUBMED]    
2.Reilly DJ. Benign transient swelling of the parotid glands following general anesthesia: "Anesthesia mumps". Anesth Analg 1970;49:560-3.  Back to cited text no. 2
[PUBMED]    
3.Berker M, Sahin A, Aypar U, Ozgen T. Acute parotitis following sitting position neurosurgical procedures: Review of five cases. J Neurosurg Anesthesiol 2004;16:29-31.  Back to cited text no. 3
[PUBMED]    
4.Izci Y, Erdogan E, Timurkaynak E. Acute right submandibular swelling following surgery for bilateral optic nerve meningioma. J Neurosurg Anesthesiol 2005;17:58-9.  Back to cited text no. 4
[PUBMED]    
5.Hans P, Demoitié J, Collignon L, Bex V, Bonhomme V. Acute bilateral submandibular swelling following surgery in prone position. Eur J Anaesthesiol 2006;23:83-4.  Back to cited text no. 5
    
6.Akçaboy EY, Akçaboy ZN, Alkan H, Gogus N. "Anesthesia mumps" after electroconvulsive therapy anesthesia. J Ect 2011;27:e21-2.  Back to cited text no. 6
    
7.Narang D, Trikha A, Chandralekha C. Anesthesia mumps and morbid obesity. Acta Anaesthesiol Belg 2010;61:83-5.  Back to cited text no. 7
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8.Cavaliere F, Conti G, Annetta MG, Greco A, Cina A, Proietti R. Massive facial edema and airway obstruction secondary to acute postoperative sialadenitis or "anesthesia mumps": A case report. J Med Case Rep 2009;3:7073.  Back to cited text no. 8
    
9.Yousem DM, Kraut MA, Chalian AA. Major salivary gland imaging. Radiology 2000;216:19-29.  Back to cited text no. 9
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