Airway obstruction due to incarceration of the epiglottis into the epiglottic bars during general anesthesia with a new perilaryngeal airway (CobraPLA).

The CobraPLATM is an alternative device for airway management. We report a case of airway obstruction caused by incarceration of the epiglottis in the epiglottic bars of the CobraPLATM during general anesthesia. Although the CobraPLATM was placed without difficulty on the first attempt, signs of airway obstruction were noted 2 h after insertion of the CobraPLATM. Using fiberoptic bronchoscopy, we observed incarceration and distortion of the epiglottis by the epiglottic bars of the CobraPLATM (Figure 1), obstructing the view of the vocal cords. It appears that the distal portion of the CobraPLATM moved upward, from the hypopharynx to the mesopharynx, entrapping the epiglottis in the epiglottic bars. After reinsertion of the CobraPLATM, the airway was restored. The CobraPLATM is a supraglottic airway that shares some features with the laryngeal mask airway, including epiglottic bars. However, the laryngeal mask airway has only two bars, whereas the CobraPLATM has six narrowly spaced bars. Incarceration of the epiglottis between the epiglottic bars may be facilitated by the narrow spacing in the CobraPLATM.