Fractured laryngeal mask airway (LMA).

To the Editor: In a 65-yr-old man undergoing elective cystolithopaxy anesthesia was induced and a size 4 LMA (Intavent, Oxon, UK) inserted. At emergence, the patient bit on the LMA shaft, shearing it into two pieces (Figure). The proximal shaft outside his clenched teeth was severed. The distal shaft and the inflated LMA remaining inside the patient’s mouth. A facemask with oxygen was applied. He maintained spontaneous breathing but did not open his mouth. One minute later, his mouth opened and the LMA was removed using McGill forceps after cuff deflation. Examination of the LMA showed a spiral fracture of the distal shaft and marked yellowish discoloration of the shaft. The manufacturing date was the second quarter of 1991. Autoclaving (steam, 134°C) at our hospital conforms to the manufacturer’s recommendations.1 We estimate that this LMA had been autoclaved over 400 times. The Canadian supplier (Vitaid, Toronto) recommended the following to ensure safety:1,2 first, record each autoclaving and discard after 40 uses; second, before each use, check colour of shaft, aperture bars, competency of pilot balloon valve, competency of LMA cuff, 15 mm connector fit; third, flex the shaft 180° and observe for kinking; fourth, use a bite block. This case illustrates the potential risk of a fractured LMA due to excessive re-use. Although dramatic in presentation, the patient had no sequlae. It is important to retrieve all pieces of the fractured LMA and that none is aspirated into the lungs.