Although rare, vallecular cysts can have catastrophic consequences in an anaesthetised patient if airway management is inappropriate. We report a case of difficult intubation in a 46-year-old man with a vallecular cyst, and detail the methods and strategies for successful endotracheal tube insertion. Following a review of the current literature, we also discuss airway management options in adult patients with vallecular cysts.
Airway Management ; Airway Obstruction ; diagnosis ; surgery ; Anesthesiology ; methods ; Cysts ; diagnosis ; surgery ; Humans ; Intubation, Intratracheal ; methods ; Laryngeal Diseases ; diagnosis ; surgery ; Laryngoscopy ; Male ; Middle Aged

INTRODUCTIONThe LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia.

METHODS150 patients who underwent general anaesthesia for elective surgery were randomly allocated into three groups. Data was collected on oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion, and airway safety.

RESULTSLeak pressure, our primary outcome measure, was found to be higher for the i-gel than the Supreme and ProSeal (mean ± standard error of the mean: 27.31 ± 0.92 cmH2O, 23.60 ± 0.70 cmH2O and 24.44 ± 0.70 cmH2O, respectively; p = 0.003). Devices were inserted on the first attempt for 90%, 82% and 72% of patients in the i-gel, Supreme and ProSeal groups, respectively (p = 0.105); mean device placement times were 23.58 seconds, 25.10 seconds and 26.34 seconds, respectively (p = 0.477). Gastric tubes were inserted on the first attempt in 100% of patients in the Supreme group, and 94% of patients in the i-gel and ProSeal groups (p = 0.100). There was blood staining on removal in 9 (18%) patients in each of the Supreme and ProSeal groups, with none in the i-gel group (p = 0.007). The incidence of postoperative sore throat, dysphagia and hoarseness was lowest for the i-gel.

CONCLUSIONThe three devices were comparable in terms of ease and duration of placement, but the i-gel had higher initial oropharyngeal leak pressure and lower airway morbidity compared with the ProSeal and Supreme.

Adult ; Aged ; Aged, 80 and over ; Anesthesia ; Anesthesia, General ; Deglutition Disorders ; complications ; Elective Surgical Procedures ; Equipment Design ; Female ; Humans ; Laryngeal Masks ; Male ; Middle Aged ; Oropharynx ; Pharyngitis ; Postoperative Period ; Pressure ; Respiration, Artificial ; Young Adult