Unilateral Hypoglossal Nerve Palsy after Use of the Laryngeal Mask Airway Supreme

Purpose.Hypoglossal nerve palsy after use of the laryngeal mask airway (LMA) is an exceptionally rare complication. We present the first case of unilateral hypoglossal nerve palsy after use of the LMA Supreme.Clinical Features.A healthy 67-year-old female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. A size 4 LMA Supreme was inserted successfully at the first attempt and the cuff was inflated with air at an intracuff pressure of 60 cmH2O using cuff pressure gauge. Anesthesia was maintained with oxygen, nitrous oxide (67%), and sevoflurane under spontaneous breathing. The surgery was uneventful and the duration of anesthesia was two hours. The LMA was removed as the patient woke and there were no immediate postoperative complications. The next morning, the patient complained of dysarthria and dysphasia. These symptoms were considered to be caused by the LMA compressing the nerve against the hyoid bone. Conservative treatment was chosen and the paralysis recovered completely after 5 months.Conclusion.Hypoglossal nerve injury may occur despite correct positioning of the LMA under the appropriate intracuff pressure. A follow-up period of at least 6 months should be taken into account for the recovery.

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Unilateral hypoglossal nerve palsy after the use of laryngeal mask airway (LMA) Protector

Korean Journal of Anesthesiology ◽

10.4097/kja.d.18.00354 ◽

2019 ◽

Vol 72 (6) ◽

pp. 606-609 ◽

Cited By ~ 1

Author(s):

Li Yeen Tham ◽

Zhi Yuen Beh ◽

Ina Ismiarti Shariffuddin ◽

Chew Yin Wang

Keyword(s):

Laryngeal Mask Airway ◽

Nerve Palsy ◽

Hypoglossal Nerve ◽

Laryngeal Mask ◽

Hypoglossal Nerve Palsy

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Hypoglossal Nerve Palsy as Complication of Oral Intubation, Bronchoscopy and Use of the Laryngeal Mask Airway

European Neurology ◽

10.1159/000057906 ◽

2002 ◽

Vol 47 (4) ◽

pp. 239-243 ◽

Cited By ~ 44

Author(s):

Rainer Dziewas ◽

Peter Lüdemann

Keyword(s):

Laryngeal Mask Airway ◽

Nerve Palsy ◽

Hypoglossal Nerve ◽

Laryngeal Mask ◽

Oral Intubation ◽

Hypoglossal Nerve Palsy

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Hypoglossal nerve palsy following the use of laryngeal mask airway

Trends in Anaesthesia and Critical Care ◽

10.1016/j.tacc.2014.03.003 ◽

2014 ◽

Vol 4 (4) ◽

pp. 127-128

Author(s):

Hemlata Kapoor ◽

Sanjiv Badhwar ◽

Neepa Vellimuttam

Keyword(s):

Laryngeal Mask Airway ◽

Nerve Palsy ◽

Hypoglossal Nerve ◽

Laryngeal Mask ◽

Hypoglossal Nerve Palsy

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Isolated Hypoglossal Nerve Palsy Due to Endovascular Treatment of a Dural Arteriovenous Fistula with Onyx-18

Interventional Neuroradiology ◽

10.1177/159101991001600310 ◽

2010 ◽

Vol 16 (3) ◽

pp. 286-289 ◽

Cited By ~ 13

Author(s):

W. Pei ◽

S. Huai-Zhang ◽

X. Shan-Cai ◽

G. Cheng ◽

Z. Di

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Nerve Palsy ◽

Dural Arteriovenous Fistula ◽

Hypoglossal Nerve ◽

Transvenous Embolization ◽

Prednisolone Therapy ◽

Hypoglossal Nerve Palsy ◽

Hypoglossal Canal ◽

First Case

We describe a patient with dural arteriovenous fistula (DAVF) treated with Onyx-18 who developed isolated hypoglossal nerve palsy. This is the first case of isolated hypoglossal nerve palsy caused by Onyx-18 embolization. This complication suggests that over embolization with Onyx-18 in the treatment of hypoglossal canal DAVFs should be avoided, and transvenous embolization may be safer. Furthermore, prednisolone therapy should be carried out in the prophase of nerve palsy.

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Postoperative Pharyngolaryngeal Adverse Events with Laryngeal Mask Airway (LMA Supreme) in Laparoscopic Surgical Procedures with Cuff Pressure Limiting 25 cmH2O: Prospective, Blind, and Randomised Study

The Scientific World JOURNAL ◽

10.1155/2014/709801 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Joo-Eun Kang ◽

Chung-Sik Oh ◽

Jae Won Choi ◽

Il Soon Son ◽

Seong-Hyop Kim

Keyword(s):

Laryngeal Mask Airway ◽

Adverse Events ◽

Surgical Procedures ◽

Cuff Pressure ◽

Laryngeal Mask ◽

Cuff Volume ◽

Randomised Study ◽

Pressure Groups ◽

Laparoscopic Surgical Procedures ◽

Lma Supreme

To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60 cmH2O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25 cmH2O, L group) and high (at 60 cmH2O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25 cmH2O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered withKCT0000334.

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Pharyngolaryngeal Morbidity with the Laryngeal Mask Airway in Spontaneously Breathing Patients

Anesthesiology ◽

10.1097/00000542-200105000-00012 ◽

2001 ◽

Vol 94 (5) ◽

pp. 760-766 ◽

Cited By ~ 41

Author(s):

Deirdre M. Grady ◽

Fiona McHardy ◽

Jean Wong ◽

Fengling Jin ◽

Doris Tong ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Sore Throat ◽

Cuff Pressure ◽

Body Movement ◽

Laryngeal Mask ◽

Nausea And Vomiting ◽

Intracuff Pressure ◽

Increased Risk ◽

Male Patients ◽

Spontaneously Breathing

Background Currently, the manufacturer of the laryngeal mask airway (LMA; Laryngeal Mask Company, Ltd., Northfield End, Henley on Thames, Oxon, United Kingdom) recommends using as large a mask size as possible. The aim of this study was to compare the incidence of pharyngolaryngeal morbidity after the use of a large (size 5 in males and size 4 in females) or small (size 4 in males and size 3 in females) LMA in spontaneously breathing patients. Methods A total of 258 male and female patients were randomly assigned to insertion of a large or small LMA while breathing spontaneously during general anesthesia. After insertion of the LMA, a "just-seal" cuff pressure was obtained, and intracuff pressure was measured at 10-min intervals until just before removal of the LMA. The 2- and 24-h incidence of postoperative sore throat, pain, hoarseness, dysphagia, and nausea and vomiting was assessed. Complications after LMA removal, including body movement, coughing, retching, regurgitation, vomiting, biting on the LMA, bronchospasm, laryngospasm, or the presence of blood on the LMA, were recorded. Results The use of a large LMA was associated with a higher incidence of sore throat in both sexes (20% vs. 7% in men, 21% vs. 5% in women; P < 0.05) and a higher incidence of hoarseness in male patients at 2 h postoperatively (21% vs. 9%, P < 0.05). There was a higher incidence of sore throat in male patients at 24 h postoperatively with the use of a large LMA (26% vs. 12%, P < 0.05). There was no difference in the incidence of complications of LMA removal orother pharyngolaryngeal morbidity, such as difficulty swallowing, drinking, and eating, or nausea and vomiting, between male or female groups at any time period with the use of a large LMA. Conclusions Selection of a small laryngeal mask airway (size 4) in spontaneously breathing male patients may be more appropriate to limit the occurrence of sore throat on the first postoperative day. All patients had a fourfold increased risk of developing sore throat when a large LMA was used.

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Hypoglossal nerve palsy after gasless trans-axillary endoscopic thyroidectomy: a case report

BMC Surgery ◽

10.1186/s12893-021-01114-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiao-Fei Liu ◽

Zhe-Wei Zhao ◽

Ming Cui ◽

Sen Yang ◽

Quan Liao

Keyword(s):

Thyroid Carcinoma ◽

Nerve Palsy ◽

Hypoglossal Nerve ◽

Endoscopic Thyroidectomy ◽

Vitamin B1 ◽

Needle Aspiration ◽

Hypoglossal Nerve Palsy ◽

First Case ◽

Benign Goiter ◽

The Right

Abstract Background Gasless trans-axillary endoscopic thyroidectomy (GTAET) has satisfactory cosmetic effects for the patients who have benign goiter and small thyroid carcinoma, however the complications of this surgical procedure have not been fully documented. Ipsilateral hypoglossal nerve palsy (IHNP) associated with GTAET has never been reported before. Case presentation A 33-year old male patient presented with a 4 × 5 mm solid thyroid nodule in the right lobe. Papillary thyroid carcinoma was confirmed by the fine needle aspiration. He had strong cosmetic demand, therefore GTAET for right lobectomy and central cervical lymphadenectomy was performed in a supine position with cervical extension. Six hours after the operation, he developed tongue deviation to the right side, speech and swallowing difficulties, indicating IHNP. Head and cervical MRI showed no abnormality. The intravenous steroid was used for three days, and oral vitamin B1 and mecobalamin was prescribed for 1 month. Nine days after surgery, he was discharged. Three months after the operation, all the symptoms were completely resolved. Conclusions To the best of the authors’ knowledge, this is the first case of IHNP after GTAET, which will be valuable to add our knowledge to diagnose and treat rare complications of GTAET.

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Prospective Clinical and Fiberoptic Evaluation of the Supreme Laryngeal Mask Airway ™

Anesthesiology ◽

10.1097/aln.0b013e3181942c4d ◽

2009 ◽

Vol 110 (2) ◽

pp. 262-265 ◽

Cited By ~ 16

Author(s):

Arnd Timmermann ◽

Stefan Cremer ◽

Christoph Eich ◽

Stephan Kazmaier ◽

Anselm Bräuer ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Cuff Pressure ◽

Laryngeal Mask ◽

Leak Pressure ◽

Cuff Volume ◽

Oropharyngeal Leak Pressure ◽

Company Limited ◽

Patient Reported ◽

The Mean ◽

Lma Supreme

Background In March 2007, a new disposable laryngeal mask airway (LMA) became available. The LMA Supreme (The Laryngeal Mask Company Limited, St. Helier, Jersey, Channel Islands) aims to combine the LMA Fastrach feature of easy insertion with the gastric access and high oropharyngeal leak pressures of the LMA ProSeal. Methods The authors performed an evaluative study with the LMA Supreme, size 4, on 100 women to measure the ease of insertion, determinate the laryngeal fit by fiberoptic classification, evaluate the oropharyngeal leak pressure, and report adverse events. Results Insertion of the LMA Supreme was possible in 94 patients (94%) during the first attempt, and in 5 patients (5%) during the second attempt. In one small patient, the LMA Supreme could not be inserted because of limited pharyngeal space. This patient was excluded from further analysis. Insertion of a gastric tube was possible in all patients at the first attempt. The median time for LMA Supreme insertion was 10.0 s (+/-4.7 s; range, 8-30 s). Laryngeal fit, evaluated by fiberscopic view, was rated as optimal in all patients, both immediately after insertion of the LMA Supreme and at the end of surgery. After equalization to room pressure, the mean cuff volume needed to achieve 60 cm H2O cuff pressure was 18.4 ml (+/-3.8 ml; range, 8-31 ml). The mean oropharyngeal leak pressure at the level of 60 cm H2O cuff pressure was 28.1 cm H2O (+/-3.8 cm H2O, range, 21-35 cm H2O). Eight patients (8.1%) complained of a mild sore throat. No patient reported dysphagia or dysphonia. Conclusions Clinical evaluation of the LMA Supreme showed easy insertion, optimal laryngeal fit, and low airway morbidity. Oropharyngeal leak pressure results were comparable to earlier data from the LMA ProSeal.

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