Severe bradycardia in a patient undergoing endovascular stent-graft repair for abdominal aortic aneurysm with vena cava balloon occlusion.

grille, larynx seen by manipulation of the fibrescope; grade 4, epiglottis down-folded, larynx not seen. The results are shown in the Table. In five of the seven patients, the LMA provided an acceptable patent airway. In the remaining two patients (cases three and six), however, down-folding of the epiglottis caused severe airway obstruction. In case three, establishment of a patent airway via the LMA was unsuccessful despite three attempts at insertion. Subsequently, tracheal intubation succeeded by direct laryngoscopy. In case six, the down-folding of the epiglottis was partially relieved by moving the LMA in an oral direction. However, this correction of LMA placement did not provide an acceptable patent airway. In this case, SpO2 decreased to 80% after insertion of the LMA; it immediately increased (> 97%) after recovery of spontaneous breathing. At that point, fibrescope-aided tracheal intubation through the LMA was performed. Despite the small sample size in this study, failure to establish a patent airway with the LMA in two patients shows that the LMA cannot always provide a patent airway in TCS patients. Accordingly, careful consideration is necessary in the elective use of the LMA in TCS patients.