Severe multiorgan failure caused by aspiration with laryngeal mask airway

We report a case of a 77-year-old woman who developed severe multiple organ failure after aspiration with the LMA during ureteral splinting. Two hours after induction of anaesthesia the urologists decided for nephrostomy in prone position. Therefore the patient was intubated. During removal of the LMA bilious secretion was recognized inside the LMA and in the pharynx. Endotracheal suction and immediate bronchoscopy showed severe aspiration. After the operation the patient was submitted to the ICU. She developed a severe multiple organ failure within 12 hours. Recovery took 54 days. The discussion is focussed on risk factors for the use of the LMA, adequate intraoperative monitoring, possible disadvantages of the applied anaesthetic technique and initial treatment after aspiration.