General Anesthesia with Laryngeal Mask Proves Safe for Complex Head Tumor Surgery, Indonesian Case Report Shows
A clinical team from Universitas Malikussaleh and Cut Meutia General Hospital in Aceh, Indonesia, has reported that general anesthesia using a laryngeal mask airway (LMA) can be a safe and effective option for selected head tumor surgeries. The findings were published in 2026 in the International Journal of Integrative Sciences (IJIS) by Haur Syakira Radra, Raissa Amanda Helsah, and Dicky Noviar. The report documents the successful anesthetic management of a 57-year-old male patient undergoing wide tumor excision and flap reconstruction for a rare malignant peripheral nerve sheath tumor (MPNST), highlighting practical implications for anesthesia practice in oncology surgery.
The case matters because MPNST is an aggressive and uncommon cancer with a high risk of recurrence, often requiring extensive surgery. Head and neck tumor operations pose unique challenges for anesthesiologists, particularly in maintaining airway safety and stable circulation. This report adds real-world evidence that, under the right conditions, LMA-based general anesthesia can support safe surgery and smooth recovery without airway complications.
Why this case is important
Malignant peripheral nerve sheath tumor is a rare soft tissue cancer arising from peripheral nerves or their surrounding cells. It affects an estimated 0.001 percent of the general population but carries a poor prognosis due to its aggressive behavior and recurrence rates of up to 60 percent. While MPNST most commonly appears in the extremities and trunk, it can also develop in the head and neck region, where surgical management becomes more complex.
According to the authors from Universitas Malikussaleh, wide excision with clear margins remains the primary treatment to reduce recurrence. In the head region, this often results in large tissue defects that must be reconstructed using skin grafts or flaps. These procedures demand careful anesthetic planning to ensure patient safety, minimize hemodynamic instability, and protect the airway throughout surgery.
Case overview and clinical context
The IJIS article describes a 57-year-old male patient from Aceh who presented with an enlarging mass on the right side of his head. Over eight months, the mass grew from approximately 3 centimeters to 10 centimeters in diameter, causing discomfort, itching, and sleep disturbance. Clinical evaluation and diagnostic workup led to a diagnosis of malignant peripheral nerve sheath tumor in the right parietal region.
The patient had no significant medical comorbidities such as hypertension, diabetes, or asthma and was classified as American Society of Anesthesiologists (ASA) physical status II. Surgeons planned a wide tumor excision followed by flap reconstruction to close the surgical defect.
Given the tumor location and expected surgery duration of about 90 minutes, the anesthesia team opted for general anesthesia using a laryngeal mask airway rather than endotracheal intubation.
How the anesthesia was managed
The anesthetic approach was designed to balance safety, comfort, and rapid recovery. Induction was achieved using propofol for hypnosis and fentanyl for pain control. Airway management was performed with an appropriately sized LMA, allowing effective ventilation without placing a tube into the trachea.
Throughout the operation, the patient’s vital signs remained stable. Blood pressure stayed within the range of 120–130/70–85 mmHg, oxygen saturation remained at 99–100 percent, and heart rate was well controlled. The surgery proceeded without airway difficulty, aspiration risk, or major hemodynamic fluctuations.
Postoperative recovery was smooth. The patient regained full consciousness in the recovery room, reported manageable pain levels, and experienced no nausea, vomiting, or airway complications. He was transferred back to the ward with a high recovery score, indicating good anesthetic outcomes.
Key findings from the case
The authors highlight several important observations from this clinical report:
1. Stable airway control: The LMA provided reliable ventilation throughout surgery without airway trauma or obstruction.
2. Hemodynamic stability: Blood pressure and heart rate remained within safe limits during induction, maintenance, and recovery.
3. Good postoperative recovery: The patient experienced rapid awakening, effective pain control, and no respiratory complications.
These findings reinforce the idea that LMA can be a practical alternative to endotracheal intubation in selected head and neck tumor surgeries.
Implications for anesthesia practice
For anesthesiologists and surgical teams, this case offers evidence-based reassurance that less invasive airway devices can be safely used in oncologic procedures when patient selection is appropriate. LMA use is associated with reduced airway irritation, less sympathetic response during insertion, and faster recovery of protective reflexes.
The authors from Universitas Malikussaleh emphasize that successful anesthesia management depends on comprehensive preoperative evaluation, careful monitoring, and adherence to multimodal pain control principles. “General anesthesia with LMA can be a safe and effective airway management option for selected head tumor surgeries with low aspiration risk and moderate operative duration,” the authors note in their discussion.
Beyond clinical practice, the findings may influence hospital protocols and training, particularly in regional or resource-limited settings where optimizing recovery time and reducing complications is critical.
Broader relevance for patients and healthcare systems
For patients, safer anesthesia techniques translate into faster recovery, fewer complications, and improved surgical experiences. For healthcare systems, efficient anesthesia management supports shorter recovery room stays and better use of operating room resources.
This case also aligns with Enhanced Recovery After Surgery (ERAS) principles, which prioritize stable physiology, effective pain control, and early recovery. By demonstrating real-world application of these principles in head tumor surgery, the article contributes to ongoing efforts to improve perioperative care quality.
Author profiles
Haur Syakira Radra, Universitas Malikussaleh Indonesia.
Raissa Amanda Helsah Universitas Malikussaleh, Indonesia.
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