Anaesthesia mumps in a child: A rare entity.

Sir,

Anaesthesia mumps is an acute transient swelling of the parotid glands following general anaesthesia. It was first described by Attas et al. in 1968.[1] Since then there have been various case reports documenting the occurrence of this benign condition in adults in different type of surgeries.[23] However, there is a paucity of literature regarding its existence in the paediatric population compared to adults. We recently witnessed this condition in an 8-year-old child, weighing 25 kg, being operated for open reduction and fixation of the dislocated head of radial bone in the supine position under general anaesthesia. Standardized anaesthesia protocol was followed. The surgery went on for 1 h and 20 min. The trachea of the patient was extubated at the end of surgery after complete reversal of neuromuscular blockade. Postoperatively, bilateral swelling of the parotid glands extending till the angle of the mandible was noticed [Figure 1]. The swelling gradually subsided within 12 h without any sequelae. The parents of the child were counselled, and the benign nature of the condition was explained.

Figure 1

Enlargement of parotid gland after surgery

The exact aetiology of anaesthesia mumps, also known as acute transient postoperative sialadenitis or surgical mumps is still not known. Dehydration, parasympathetic stimulation, coughing/straining against the endotracheal tube and positioning of the patient during surgery have been shown to play a role in the development of postoperative transient sialadenitis. Increase in secretions along with improper drainage results in accumulation of saliva causing enlargement of the parotid gland. Various anaesthetic agents like benzodiazepines, ketamine, neuromuscular blocking agents, anaesthetic gases and unhumidified oxygen have been linked with this benign condition.[4] Contrary to our case, most of the previous reports showed the development of parotid swelling in surgeries done either in lateral or prone position or after prolonged duration of surgery in the supine position. This highlights the fact that the perioperative factors other than the patient positioning or duration of surgery play an important role in the development of parotid swelling, which need to be taken care of during perioperative anaesthetic management. Anaesthesia mumps rarely leads to any complications. No specific treatment is warranted in most of the cases. Painful enlargement of the glands can be treated with hot fomentation and non-steroidal anti-inflammatory drugs. Rarely massive swelling of the parotid gland can lead to airway obstruction or facial nerve palsy.[5] These cases may require more aggressive management in the form of steroids, antibiotics or even a tracheostomy for airway management.

Fortunately in our case, no life-threatening complication was witnessed. Coughing and straining against the endotracheal tube at the end of surgery could be one of the contributing factors in this case.

Reporting of such cases creates awareness among the health care professionals regarding this benign condition. It also emphasizes the need for proper hydration and smooth extubation to prevent the occurrence of anaesthesia mumps.