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.