• Tung-Ying Tsai, Pei-Jung Chang, Shih-Hsuan Chen, Yen-Chin Liu, Yen-Hui Sung, and Yu-Chuan Tsai.
• Department of Anesthesiology, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC. tongying@mail.ncku.edu.tw
• Acta Anaesthesiol Taiwan. 2006 Mar 1;44(1):39-42.

AbstractA 35-day-old male infant was scheduled for bilateral inguinal herniorrhaphy. No history of recent upper airway infection or other reactive respiratory disease was noted before anesthesia. Breath holding was noted immediately after laryngeal mask airway (LMA) insertion. Removal of the LMA and positive pressure ventilation via face mask did not solve the problem. On suspicion of laryngospasm, tracheal intubation facilitated by muscule relaxant was performed. However, when the patient was ventilated, high airway pressure, absence of chest wall movement and elevated end-tidal CO2 were noted. Despite visual confirmation of correct placement of tracheal tube, oxygen desaturation and bradycardia developed rapidly. After deepening the inhalational anesthesia of sevoflurane and concomitant administration of intravenous lidocaine, the patient's respiratory condition turned for the better and became compliable. Respiratory dysfunction may be caused by severe bronchospasm induced by placement of the LMA. The pathophysiology and risk factors of bronchospasm related to the LMA placement are discussed in the text.

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