Zhao Y, Li P, Li DW, Zhao GF, Li XY. Severe gastric insufflation and consequent atelectasis caused by gas leakage using AIR-Q laryngeal mask airway: A case report. World J Clin Cases 2022; 10(11): 3541-3546 [PMID: 35582056 DOI: 10.12998/wjcc.v10.i11.3541]
Corresponding Author of This Article
De-Wei Li, PhD, Doctor, Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou 510120, Guangdong Province, China. leedewei1123@sina.com
Research Domain of This Article
Respiratory System
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 16, 2022; 10(11): 3541-3546 Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3541
Severe gastric insufflation and consequent atelectasis caused by gas leakage using AIR-Q laryngeal mask airway: A case report
Yue Zhao, Ping Li, De-Wei Li, Gao-Feng Zhao, Xiang-Yu Li
Yue Zhao, Ping Li, De-Wei Li, Gao-Feng Zhao, Xiang-Yu Li, Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Author contributions: Zhao Y and Li DW reviewed the literature and contributed to manuscript drafting; Li P and Li XY were responsible for project administration and data curation; Zhao GF was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: De-Wei Li, PhD, Doctor, Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou 510120, Guangdong Province, China. leedewei1123@sina.com
Received: December 7, 2021 Peer-review started: December 7, 2021 First decision: January 12, 2022 Revised: January 23, 2022 Accepted: February 23, 2022 Article in press: February 23, 2022 Published online: April 16, 2022 Processing time: 121 Days and 18.3 Hours
Abstract
BACKGROUND
The airways of patients undergoing awake craniotomy (AC) are considered “predicted difficult airways”, inclined to be managed with supraglottic airway devices (SADs) to lower the risk of coughing or gagging. However, the special requirements of AC in the head and neck position may deteriorate SADs’ seal performance, which increases the risks of ventilation failure, severe gastric insufflation, regurgitation, and aspiration.
CASE SUMMARY
A 41-year-old man scheduled for AC with the asleep–awake–asleep approach was anesthetized and ventilated with a size 3.5 AIR-Q intubating laryngeal mask airway (LMA). Air leak was noticed with adequate ventilation after head rotation for allowing scalp blockage. Twenty-five minutes later, the LMA was replaced by an endotracheal tube because of a change in the surgical plan. After surgery, the patient consistently showed low tidal volume and was diagnosed with gastric insufflation and atelectasis using computed tomography.
CONCLUSION
This case highlights head rotation may cause gas leakage, severe gastric insufflation, and consequent atelectasis during ventilation with an AIR-Q intubating laryngeal airway.
Core Tip: AIR-Q intubating laryngeal airway is a feasible airway management method for predicted difficult airways and has been proven to involve fewer complications and a shorter ventilation duration than fiberoptic intubation. This case highlights that head rotation during ventilation with an AIR-Q intubating laryngeal airway may lead to gas leakage, severe gastric insufflation, and consequent atelectasis; this indicates that physicians should pay attention to patient position changes when using laryngeal mask airway.
