Prof. Mridul M. Panditrao

Consultant Department of Anesthesiology and

Critical care Rand memorial hospital

Freeport Bahamas

ANAESTHESIA MUMPS

ANAESTHESIA MUMPS

Reilly in 1971

Benign self limiting enlargement of parotid glands appearing after general anaesthesia

Relatively unknown & an under documented condition

Our Experience

21 cases of Anaesthesia mumps Out of 1707 cases operated GA for

various causes during the course of one year

Incidence of Anaesthesia mumps 12.3 per thousand

Age range 18 – 65 yrs M/F ratio 1:1

3 Prototype cases

3 prototype cases were chosen due to the difference in the nature and methodology of GA administered

Thorough preanaesthetic checkup done

No parotid gland swelling preoperatively

Case - 1

64 y/o male posted for wide local excision of keratinizing squamous intra epithelial neoplasia of buccal mucosa

Premedication Inj Atropine 0.6mg, Inj Midazolam 1mg,

Inj Butorphanol 1mg IV

Induction Inj Thiopentone 350mg, Inj

Succinylcholine 100mg IV

Case - 1

Intubation Nasally with 7.5 RAE tube north pole after D/L

scopy Oral packing done

Maintenance IPPV with O2, N2O & Isoflurane Non depolarizing muscle relaxant: Inj

Vecuronium IV

Position Supine, head turned to left

Case - 1

Duration of surgery 120 min

Reversal Inj Neostigmine 2.5mg, Inj Atropine

1.2mg IV Pack removal & Extubation

Bilateral parotid swelling observed 2 min after extubation

Swelling resolved after 4 days

Case - 2

60 y/o male posted for electroconvulsive therapy for schizophrenia

Premedication Inj Glycopyrrolate 0.2 mg IV

Induction Inj Thiopentone 250mg, Inj

Succinylcholine 75 mg IV

Case - 2

Mask ventilation IPPV with 100% O2 Duration 15 min

Position Supine

Bilateral parotid gland swelling appeared on regaining spontaneous ventilation

Swelling resolved after 3 days

Case - 3

30 y/o female posted for MRM

Premedication Inj Glycopyrrolate 0.2 mg, Inj

Midazolam 1mg, Inj Butorphanol 1mg IV

Induction Inj Thiopentone 300mg, Inj Rocuronium

35 mg IV

Case - 3

Intubation Orally with 7.5 ETT after D/L scopy

Maintenance IPPV with O2, N2O & Isoflurane

Duration of surgery 180 min

Position Supine

Case - 3

Reversal Inj Neostigmine 2.5mg, Inj Atropine

1.2mg IV Patient extubated

Bilateral parotid gland swelling was observed on table immediately after extubation

Swelling resolved after 4 days

3 Prototype cases

Local Examination

B/L Swelling of parotid gland

Size: 4 3 1.5 cm

Diffuse, non tender, freely mobile

No change in colour or

temperature

Non Anaesthetic Causes of Parotid Enlargement

Glandular inflammation Infection Allergic reaction Ductal outlet obstruction Stones Tumor Trauma Antihistamines Diuretics Dehydration

Anaesthetic Causes of Parotid Enlargement

Benzodiazepines Ketamine Neuro Muscular Blocking Drugs Anaesthetic gases & Unhumidified O2 Increased salivary secretions Decreased salivary outflow

Pneumoparotiditis due to Intraoral pressure: In glass blowers: During mask ventilation

ANAESTHESIA MUMPS

Probable causes Fluid stasis Ductal spasm

Clinical course

Spontaneous resolution of the swelling within 3 – 5 days

No respiratory distress or obstruction

Conclusion

Benign Relatively unknown Not so uncommon Self Resolving Condition which rarely leads to any

complications.

No Specific treatment needed Simple assurance