Failed Ventilation Immediately after Skin Incision during General Anesthesia with a Laryngeal Mask Airway

Abstract

Ventilation difficulty during general anesthesia via laryngeal mask airway (LMA) has been a subject of debate since its developments. Here, we present a patient who experienced difficulty of ventilation immediately after initial skin incision followed by a period of sufficient ventilation. The difficulty of ventilation was not relieved by positive pressure ventilation or propofol injection. Ventilation recovered after administration of rocuronium. We assumed that closure of the vocal cords caused a sudden obstruction of the airway and that subsequent administration of a neuromuscular blocking agent restored airway patency by opening a closed vocal cord. This case report may support the potential importance of neuromuscular blocking agents for management and prevention of difficult ventilation that may occur with LMA.