Postoperative Hiccup Induced by LMA—A Case Report with Literature Review

C. C. Nwagwu¹, L. N. Ebirim^2*

¹Department of Anaesthesia, Niger Delta University Teaching Hospital, Okolobiri, Nigeria.
²Department of Anaesthesiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

DOI: 10.4236/ojanes.2014.410035                

Abstract

Background: The laryngeal mask airway (LMA) has become popular due to simplicity of its use and its important function in difficult airway management. However, some complications have been associated with its use. A case report and review of literature on hiccups associated with the use of LMA is presented. Case Report: A 24-year-old man who presented with a right inguinoscrotal hernia was scheduled for elective surgery under general anaesthesia. He denied any co-existing medical illness. Physical examination showed a normal healthy patient and he was placed in class 1 of the American Society of Anesthesiologist (ASA) physical status category. After premedication with 0.6 mg atropine, general anaesthesia was induced with 200 mg of intravenous propofol. Size 5 classic LMA was inserted, and surgery had lasted for 45 minutes. He had hiccups immediately after removal of the LMA which lasted for 6 minutes, and stopped about 95 seconds after 0.6 mg intravenous atropine was given. Conclusion: Complications from the use of LMA may be rare but still possible. It is important to adhere to the guidelines for insertion and removal of the LMA and perioperative use of the device should strictly be by trained personnel.

Keywords

Laryngeal Mask Airway, Post-Operative Hiccups

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Brain, A.I.J. (1983) The Laryngeal Mask Airway: A New Concept in Airway Management. British Journal of Anaesthesia, 55, 801-805. http://dx.doi.org/10.1093/bja/55.8.801
[2]	Brimacombe, J. (1995) The Advantages of Laryngeal Mask Airway over the Tracheal Tube or Face Mask: A Meta-Analysis. Canadian Journal of Anaesthesia, 42, 1017-1023. http://dx.doi.org/10.1007/BF03011075
[3]	Umeh, B. (1996) The Laryngeal Mask Airway: A Critical Analysis of First 100 Consecutive Cases. Afr J Anaesth Intensive Care, 2, 56-63.
[4]	Gataure, P.S., Latto, I.P. and Rust, S. (1995) Complications Associated with Removal of Laryngeal Mask Airway: A Comparison of Removal in Deeply Anaesthetized versus Awake Patients. Canadian Journal of Anaesthesia, 42, 1113-1116. http://dx.doi.org/10.1007/BF03015098
[5]	Bapat, P., Joshi, R.N., Young, E. and Jago, R.H. (1996) Comparison of Propofol versus Thiopentone with Midazolam or Lidocaine to Facilitate Laryngeal Mask Insertion. Canadian Journal of Anaesthesia, 43, 564-568.
[6]	Becker, D.E. (2010) Nausea, Vomiting, and Hiccups: A Review of Mechanism and Treatment. Anesthesia Progress, 57, 150-156. http://dx.doi.org/10.2344/0003-3006-57.4.150
[7]	Kumar, A. (2005) Gag Reflex for Arrest of Hiccups. Medical Hypotheses, 65, 1206. http://dx.doi.org/10.1016/j.mehy.2005.08.003
[8]	Hansen, B.J. and Rosenberg, J. (1993) Persistent Postoperative Hiccups: A Review. Acta Anaesthesiologica Scandinavica, 37, 643-646. http://dx.doi.org/10.1111/j.1399-6576.1993.tb03781.x
[9]	Takahashi, T., Murata, T., Omori, M., Tagaya, M. and Wada, Y. (2004) Successful Treatment of Intractable Hiccups with Serotonin (5-HT)1A Receptor Agonist. Journal of Neurology, 251, 486-487. http://dx.doi.org/10.1007/s00415-004-0377-4
[10]	Kanaya, N., Nakayama, M., Kanaya, J. and Namiki, A. (2001) Atropine for the Treatment of Hiccup after Laryngeal Mask Airway Insertion. Anesthesia & Analgesia, 92, 791-792. http://dx.doi.org/10.1097/00000539-200109000-00047
[11]	Koteswara, C.M. and Dubey, J.K. (2013) Management of Laryngeal Mask Airway Induced Hiccups Using Dexmedetomedine. Indian Journal of Anaesthesia, 57, 85. http://dx.doi.org/10.4103/0019-5049.108583
[12]	Pinczower, G.R. (2007) Stop These Hiccups. Anesthesiology, 104, 224.
[13]	Oshima, T., Sakamoto, M. and Arita, H. (1994) Hiccuplike Response Elicited by Mechanical Stimulation of Dorsal Epipharynx of Cats. Journal of Applied Physiology, 76, 1886-1895.
[14]	Fass, R., Higa, L., Kodner, A. and Mayer, E.A. (1997) Stimulus and Site Specific Induction of Hiccups in the Oesophagus of Normal Subjects. Gut, 41, 590-593. http://dx.doi.org/10.1136/gut.41.5.590
[15]	Wilcox, S.K., Gary, A. and Johnson, M.J. (2009) Novel Use of Amantadine to Treat Hiccups. Journal of Pain and Symptom Management, 38, 460-465. http://dx.doi.org/10.1016/j.jpainsymman.2008.10.008
[16]	Renes, S.H., van Geffen, G.J., Rettig, H.C., Gielen, M.J. and Scheffer, G.J. (2010) Ultrasound-Guided Continuous Phrenic Nerve Block for Persistent Hiccups. Regional Anesthesia and Pain Medicine, 35, 455-457. http://dx.doi.org/10.1097/AAP.0b013e3181e8536f
[17]	Full-Young, C. and Ching-Liang, L. (2012) Hiccups: Mystery, Nature and Treatment. Journal of Neurogastroenterology and Motility, 18, 123-130. http://dx.doi.org/10.5056/jnm.2012.18.2.123
[18]	Vaughan, R.S. (1999) The Only Man to Have All His Work Done by Friday Was Robinson Crusoe. British Journal of Anaesthesia, 82, 663-666. http://dx.doi.org/10.1093/bja/82.5.663