Postoperative respiratory distress due to unilateral arytenoid oedema following prolonged i-gel® anaesthesia: a case report

BACKGROUND: Supraglottic airway devices are widely used for general anaesthesia owing to their ease of insertion and reduced laryngotracheal stimulation compared with tracheal intubation. Although pharyngolaryngeal complications associated with supraglottic airways are generally mild and transient, prolonged use may cause serious perilaryngeal tissue injury. We report a case of clinically significant unilateral arytenoid oedema presenting with postoperative respiratory distress following general anaesthesia with an i-gel® supraglottic airway in situ for more than seven hours. CASE PRESENTATION: A 45-year-old woman (body mass index, 26.8 kg/m2) with right upper-limb lymphoedema underwent lymphovenous anastomosis under general anaesthesia using a size-4 i-gel® supraglottic airway. The surgical procedure lasted 6 h 39 min, with a total anaesthesia time of 7 h 36 min. Intraoperative ventilation was uneventful, and the device was removed without difficulty and without visible blood staining following an uncomplicated emergence. Approximately five hours postoperatively, she developed progressive dysphagia and a sensation of throat obstruction, accompanied by intermittent oxygen desaturations to 70%. On postoperative day 1, flexible laryngoscopy revealed marked right arytenoid oedema with severely restricted abduction of the right vocal fold. Contrast-enhanced computed tomography demonstrated right-predominant supraglottic oedema extending from the vallecula to the lateral pharyngeal wall, without evidence of abscess formation or arytenoid dislocation. She was transferred to the intensive care unit for close airway monitoring and treated with systemic corticosteroids. The symptoms progressively improved over the subsequent days, and the patient was discharged on postoperative day 7 without sequelae. CONCLUSIONS: Clinically significant unilateral arytenoid and supraglottic oedema may occur following prolonged supraglottic airway use, even in the absence of apparent intraoperative complications. When an extended operative duration is anticipated, tracheal intubation should be strongly considered as the primary airway management strategy. Postoperative vigilance for airway compromise is essential, particularly after prolonged supraglottic airway use.