Department of anaesthesiology and intensive care, AZ Rivierenland, Rumst, Belgium.
General practitioner and consult in medical education, Bath, UK.
BMC Anesthesiol. 2021 Apr 5;21(1):102. doi: 10.1186/s12871-021-01322-9.
Laryngeal mask airways (LMA) are commonly used for airway management. Complications with this device are rare. However, when they do occur, there is a high risk for respiratory problems, necessitating early diagnosis and treatment. We present the first case of a life-threatening abscess spreading in the visceral space caused by a penicillin and metronidazole resistant Prevotella Denticola after the use of an LMA.
A female patient was admitted to our day care centre for bunion surgery. A single use LMA size 3 (Solus®, intersurgical, Wokingham, Berkshire, United Kingdom) was successfully inserted. After surgery, the patient complained of a sore throat and amoxicillin was prescribed by the general practitioner. Three days after surgery the patient was admitted to the Intensive Care Unit (ICU) for obstructive breathing, due to an abscess in the visceral space. Retropharyngeal and certainly parapharyngeal abscesses in adults are already rare. This case however, is unique because it is the first case of abscess spreading into the visceral space after the use of an LMA. Amoxicillin/clavulanate and vancomycin were started. The abscess was incised 5 days later and microbiology showed 3 positive cultures of the anaerobe Prevotella denticola, resistant for penicillin and metronidazole, but sensitive for amoxicillin/clavulanate. The patient fully recovered.
LMA's are easy to use and are established, safe tools to support ventilation of the airway. In this case, the authors hypothesise a small wound in the lateral pharyngeal wall probably created an opening into the visceral space causing infection with Prevotella denticola, supporting the idea that the pharyngeal mucosal space must be part of the visceral space. Additionally, early recognition and treatment of an LMA induced abscess is necessary to prevent evolution of complications leading to airway obstruction.
喉罩气道（LMA）常用于气道管理。该设备的并发症很少见。然而，当它们确实发生时，会有很高的呼吸问题风险，需要早期诊断和治疗。我们报告首例因使用 LMA 后青霉素和甲硝唑耐药的栖牙普雷沃菌引起的威胁生命的内脏空间脓肿扩散的病例。
一名女性患者因拇囊炎手术被收入日间手术中心。成功插入了一个一次性使用的 3 号 LMA（Solus ® ，intersurgical，Wokingham，Berkshire，英国）。手术后，患者诉咽痛，全科医生开了阿莫西林。手术后 3 天，患者因内脏空间脓肿导致呼吸困难被收入重症监护病房（ICU）。成人的咽后和肯定是咽旁脓肿已经很少见了。然而，这个病例很独特，因为它是首例使用 LMA 后脓肿扩散到内脏空间的病例。开始使用阿莫西林/克拉维酸和万古霉素。5 天后切开脓肿，微生物学显示 3 种厌氧菌栖牙普雷沃菌的阳性培养物，对青霉素和甲硝唑耐药，但对阿莫西林/克拉维酸敏感。患者完全康复。
LMA 易于使用，是支持气道通气的既定、安全工具。在这种情况下，作者假设侧咽壁的小伤口可能会形成一个通向内脏空间的开口，导致栖牙普雷沃菌感染，支持咽粘膜空间必须是内脏空间一部分的观点。此外，早期识别和治疗 LMA 引起的脓肿对于防止导致气道阻塞的并发症的进展是必要的。
