NEGATIVE-PRESSURE INDUCED AIRWAY AND PULMONARY INJURY

Purpose: To describe negative pressure injury occurring during the use of a laryngeal mask airway (LMA) in which airway bleeding rather than pulmonary oedema was the major complication. Clinical Features: A pat ient presented to the day surgery unit for resection of a gang!ion cys t on her right wrist. She underwent general anaesthesia using an LMA, and experienced severe laryngospasm and transient hypoxaemia (oxygen s aturation to 66%) seven minutes after incision. This removed within 90 sec of succinylcholine administration. Nonetheless, the LMA was remov ed, a tracheal tube was inserted atraumautically and positive pressure ventilation was maintained until the time of emergence, when Fresh bl ood appeared in the tracheal tube. The Mood ultimately became frothy, resembling pulmonary oedema fluid. Haemoptysis, continued postoperativ ely and led to the hospitalization of this ambulatory patient. Conclus ion: Rapid development of large subatmospheric pressures, as can occur during severe laryngospasm, may disrupt the tracheobronchial vasculat ure causing airway bleeding. This bleeding should be distinguished fro m negative pressure pulmonary oedema.