Tags

Type your tag names separated by a space and hit enter

Tapia's syndrome after arthroscopic shoulder stabilisation under general anaesthesia and LMA.
Anaesthesiol Intensive Ther. 2012 Jan-Mar; 44(1):31-4.AI

Abstract

BACKGROUND

Anaesthetic complications, albeit rare, still occur and may be severe and unanticipated, with significant morbidity. Extracranial ipsilateral palsy of the recurrent laryngeal and the hypoglossal nerves is known as the Tapia's syndrome. Damage to these nerves may result from displacement of the head during mask ventilation, endotracheal intubation, bronchoscopy or the use of a laryngeal mask airway (LMA). We describe unilateral paralysis of the muscles of the tongue and ipsilateral vocal cord due to a lesion of cranial nerves X and XII that occurred following LMA anaesthesia combined with plexus block.

CASE REPORT

A 57-year-old man with a rupture of the right shoulder underwent arthroscopic shoulder stabilisation and internal fixation. General anaesthesia with aLMA was combined with an interscalene plexus block. After induction with propofol and fentanyl, a LMA was inserted with some difficulty without muscle relaxation. The cuff was inflated with 30 mL of air and further volumes of air until a "just-seal" pressure was obtained. The anaesthesia was maintained with sevoflurane in oxygen/air. The procedure was carried out in a semi-supine position with the head inclined slightly forward, and the upper body slightly elevated. Surgery lasted 55 min and anaesthesia 70 min. After surgery, the patient quickly regained consciousness and the LMA was removed when he was responding to commands and was able to fully open his mouth. During the immediate postoperative period, the patient's voice was hoarse but he breathed without difficulty. The following day, he developed dysphagia and slurred speech; on examination, paralysis of the left side of the tongue was found. The diagnosis of an acute injury to the hypoglossal and laryngeal recurrent nerves was made and the patient was transferred to the neurology clinic for further treatment.

CONCLUSIONS

This rare complication reminds us not only of the importance of positioning during anaesthesia and surgery, but also of the need for careful and correct airway management. It could be probably prevented by careful insertion of an appropriate size LMA, and the use of low intracuff pressures and/or volumes.

Authors+Show Affiliations

Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital MSWiA in Warsaw. WAD_jack@poczta.fmNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23801511

Citation

Wadełek, Jacek, et al. "Tapia's Syndrome After Arthroscopic Shoulder Stabilisation Under General Anaesthesia and LMA." Anaesthesiology Intensive Therapy, vol. 44, no. 1, 2012, pp. 31-4.
Wadełek J, Kolbusz J, Orlicz P, et al. Tapia's syndrome after arthroscopic shoulder stabilisation under general anaesthesia and LMA. Anaesthesiol Intensive Ther. 2012;44(1):31-4.
Wadełek, J., Kolbusz, J., Orlicz, P., & Staniaszek, A. (2012). Tapia's syndrome after arthroscopic shoulder stabilisation under general anaesthesia and LMA. Anaesthesiology Intensive Therapy, 44(1), 31-4.
Wadełek J, et al. Tapia's Syndrome After Arthroscopic Shoulder Stabilisation Under General Anaesthesia and LMA. Anaesthesiol Intensive Ther. 2012 Jan-Mar;44(1):31-4. PubMed PMID: 23801511.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tapia's syndrome after arthroscopic shoulder stabilisation under general anaesthesia and LMA. AU - Wadełek,Jacek, AU - Kolbusz,Julia, AU - Orlicz,Piotr, AU - Staniaszek,Andrzej, PY - 2012/03/30/received PY - 2013/6/27/entrez PY - 2012/1/1/pubmed PY - 2014/2/11/medline SP - 31 EP - 4 JF - Anaesthesiology intensive therapy JO - Anaesthesiol Intensive Ther VL - 44 IS - 1 N2 - BACKGROUND: Anaesthetic complications, albeit rare, still occur and may be severe and unanticipated, with significant morbidity. Extracranial ipsilateral palsy of the recurrent laryngeal and the hypoglossal nerves is known as the Tapia's syndrome. Damage to these nerves may result from displacement of the head during mask ventilation, endotracheal intubation, bronchoscopy or the use of a laryngeal mask airway (LMA). We describe unilateral paralysis of the muscles of the tongue and ipsilateral vocal cord due to a lesion of cranial nerves X and XII that occurred following LMA anaesthesia combined with plexus block. CASE REPORT: A 57-year-old man with a rupture of the right shoulder underwent arthroscopic shoulder stabilisation and internal fixation. General anaesthesia with aLMA was combined with an interscalene plexus block. After induction with propofol and fentanyl, a LMA was inserted with some difficulty without muscle relaxation. The cuff was inflated with 30 mL of air and further volumes of air until a "just-seal" pressure was obtained. The anaesthesia was maintained with sevoflurane in oxygen/air. The procedure was carried out in a semi-supine position with the head inclined slightly forward, and the upper body slightly elevated. Surgery lasted 55 min and anaesthesia 70 min. After surgery, the patient quickly regained consciousness and the LMA was removed when he was responding to commands and was able to fully open his mouth. During the immediate postoperative period, the patient's voice was hoarse but he breathed without difficulty. The following day, he developed dysphagia and slurred speech; on examination, paralysis of the left side of the tongue was found. The diagnosis of an acute injury to the hypoglossal and laryngeal recurrent nerves was made and the patient was transferred to the neurology clinic for further treatment. CONCLUSIONS: This rare complication reminds us not only of the importance of positioning during anaesthesia and surgery, but also of the need for careful and correct airway management. It could be probably prevented by careful insertion of an appropriate size LMA, and the use of low intracuff pressures and/or volumes. SN - 1731-2531 UR - https://www.unboundmedicine.com/medline/citation/23801511/Tapia's_syndrome_after_arthroscopic_shoulder_stabilisation_under_general_anaesthesia_and_LMA_ DB - PRIME DP - Unbound Medicine ER -