BROKEN PIECE OF LMA-PROSEAL INTRODUCER: AN UNUSUAL CAUSE OF AIRWAY OBSTRUCTION

Dear Editor, Proseal laryngeal mask airway (PLMA) is now standard of care in many institutions due to lower risk of aspiration and better capability of ventilation. We report a case where broken tip of silicon coating of the metal introducer of PLMA caused airway obstruction in an anesthetized patient.A twenty-four year old male patient was scheduled for varicose vein stripping of left lower limb under general anesthesia. Pre-anesthetic evaluation was insignificant. General anesthesia was induced with propofol (2.5 mg.kg^-1) and fentanyl (2 mcg.kg^-1). After achieving adequate plane of anesthesia, a size four PLMA mounted on a standard introducer (which comes along with the PLMA) was inserted. After an initial failed attempt by a resident, LMA could be successfully inserted by the consultant anesthesiologist. Adequate placement was checked with acceptable chest rise with manual ventilation, bilateral equal breath sound on auscultation and appearance of regular end tidal capnogram on monitor. Patient was kept in spontaneous respiration and adequate depth of anesthesia was maintained with oxygen in 60% nitrous oxide and sevoflurane. Under strict asepsis, femoral, oburator and popliteal nerve blocks were performed with 0.25% bupivacaine under combined nerve stimulator and ultrasound guidance.