Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3541
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
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.
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.
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.