[Laryngeal mask during emergence from anesthesia in intubated patients with asthmatic attack or ischemic heart disease]

Abstract

We report two patients in whom the presence of a tracheal tube induced asthmatic attack or hemodynamic instability and the laryngeal mask was useful during emergence from anesthesia. Case 1:A 24-year-old man with asthma was scheduled for reconstruction of an amputated finger. After induction of anesthesia and neuromuscular blockade, the trachea was intubated without complications. At the end of 9.5-h uneventful operation under anesthesia with sevoflurane, nitrous oxide and oxygen, inhalational anesthetics were turned off. During emergence from anesthesia, bucking with asthmatic attack occurred. Sevoflurane and theophilline resolved the attack, which recurred after termination of sevoflurane. Under deep anesthesia with sevoflurane, the laryngeal mask was placed, and then the tracheal tube removed without complications. The laryngeal mask was removed when the patient awoke uneventfully. Case 2: A 69-year-old man with a recent history of myocardial infarction was scheduled for skin grafting. After uneventful operation, sevoflurane and nitrous oxide were turned off. Multiple premature ventricular contractions (PVCs) with hypertension and tachycardia occurred, and necessitated the restart of sevoflurane. Under deep anesthesia, the laryngeal mask was inserted and the trachea extubated, and the patient regained consciousness without complications.