Letters to the Editor: Letters & Announcements
To the Editor:
Despite widespread use, there has been only one report of dental damage during insertion of a classical laryngeal mask airway (1). We recently damaged a patient's teeth using the Fastrach™ intubating laryngeal mask airway (LMA).
The patient was a 65-yr-old man, 162 cm, 66 kg, with cervical and lumbar spine dislocation and stenosis, scheduled for lumbar laminectomy. The patient complained of neurological symptoms from head extension. Both lower first incisors had been loosened from pyorrhea alveolitis of the lower gum and were fixed to the neighboring teeth. After induction of anesthesia and neuromuscular blockade, we inserted a size 4 Fastrach LMA and passed a reinforced 8-mm endotracheal tube through the Fastrach LMA into the trachea. Leaving the Fastrach LMA in place, we turned the patient to the prone position. After an uneventful 5-h operation, we turned off the anesthesia gases and turned the patient to a supine position. Shortly after reversing neuromuscular blockade, the patient strained and bit the Fastrach LMA. On removing the Fastrach LMA and the endotracheal tube, we found the first two lower incisors were dislodged from their sockets.
A theoretical concern is that leaving the Fastrach intubating laryngeal mask in place during anesthesia may exert pressure on the posterior pharyngeal wall or on the cervical spine (2,3), but it is not clear whether this is clinically relevant. Some authors have recommended leaving the Fastrach LMA in place until the patient emerges from anesthesia (3). As shown by this case, if the patient bites on the rigid tube of the Fastrach LMA, the resulting pressure may dislodge loose teeth. In this situation it may be prudent to remove the Fastrach LMA before the patient awakens from anesthesia.
Takashi Asai, MD, PhD
Department of Anesthesiology
Kansai Medical University
1. Brimacombe J, Keller C, Fullekrug B, et al. A multicenter study comparing the ProSeal and classic laryngeal mask airway in anesthetized, nonparalyzed patients. Anesthesiology 2002;96:289–5.
2. Brimacombe J, Keller C. Cervical spine instability and the intubating laryngeal mask: a caution. Anaesth Intensive Care 1998;26:708.
3. Kiyama S, Asai T, Shingu K. Use of a laryngeal mask in a patient with an unstable neck: at induction or during emergence? Anesth Analg 1999;89:537–8.