A modified Intavent laryngeal mask for ENT and dental anaesthesia

Your readers must be told of a possible hazard attendant on the use of the Brain laryngeal mask, although I admit my own role in the story rather proves the adage that it is impossible to make things foolproof, because fools are so ingenious. The patient was a 53-year-old female for excision of a breast lump. She had a rather underdeveloped mandible, so to avoid the toil of holding on a facemask, a number 3 laryngeal mask was used after an induction of anaesthesia with 15 ml profolol (with lignocaine) and 50 pg fentanyl. The patient remained apnoeic, but the lungs were easy to ventilate by hand. Assuming that spontaneous ventilation would soon resume, I was quite happy to leave things so, since monitoring included both capnograph and pulse oximeter. For some reason now beyond me, I did not inflate the CUE occasional manual inflations produced satisfactory ventilation. Unbeknown to me, my anaesthetic nurse had inflated the cuff. When the tone of the patient's respiratory muscles returned, my hand-inflation produced a gurgle in the pharynx so I put another 20 ml of air into the cuff. Breathing became absolutely obstructed at once. Immediate removal of the apparatus (after removal of the .air from the cuff) produced a clear airway, and anaesthesia was continued with first a facemask and later, for convenience, with a tracheal tube. It was noted during the passage of the latter that the patient had a very large and floppy epiglottis. The mask was still inflated when it was removed. The effect of the extra 20 ml was to overstretch the cuff and to produce a bulge. This bulge was presumably the cause of the airway obstruction perhaps by pressure on the large epiglottis.