Anesthesia Mumps (Acute Postoperative Sialadenitis)
What is "Anesthesia Mumps"?
"Anesthesia mumps" refers to acute postoperative sialadenitis—a rare complication characterized by sudden parotid gland swelling following general anesthesia, unrelated to mumps virus infection. This condition can develop rapidly after surgery and may cause significant airway compromise requiring emergent intervention 1.
Clinical Presentation and Recognition
The condition manifests as:
- Acute parotid gland enlargement occurring in the immediate postoperative period 1
- Unilateral or bilateral facial swelling that can extend to parapharyngeal spaces 1
- Potential pharyngeal edema involving the soft palate and uvula, which may critically narrow the airway 1
- Rapid onset, typically within hours of extubation 1
Critical Pitfall
The most dangerous complication is airway obstruction from pharyngeal edema—this can necessitate emergent reintubation 1. Vigilant postoperative monitoring is essential, particularly in the recovery room setting.
Anesthetic Management Considerations
Airway Management Strategy
Extubation should occur in the operating theatre rather than the recovery room whenever possible to allow for immediate reintubation if acute swelling develops 2. If extubation must occur in the recovery room:
- Maintain minimum 7-8 meter distance between patients if extubation is performed in recovery 2
- Have immediate access to reintubation equipment 2
- Ensure the most experienced provider manages the airway 2
Infection Control Precautions
While "anesthesia mumps" is not infectious (unlike viral mumps 3, 4, 5), standard infection control practices apply:
- Maximal barrier precautions for invasive procedures including full hand washing, sterile gloves and gown, cap, mask, and large sterile drape 2
- Surgical mask type II/IIR for routine perioperative care 2
- Strict hand hygiene throughout the perioperative period 2
Regional vs. General Anesthesia
Prioritize regional anesthesia techniques whenever feasible to avoid airway manipulation and reduce the risk of postoperative complications 2. Regional analgesia and infiltration techniques should be considered as alternatives 2.
When general anesthesia is required:
- Use video laryngoscopy for intubation 2
- Minimize airway manipulation
- Plan for controlled extubation with appropriate monitoring
Distinguishing from Viral Mumps
True mumps virus infection presents differently:
- Viral mumps causes systemic illness with parotitis, potential aseptic meningitis, encephalitis, orchitis, and pancreatitis 3, 4, 5, 6
- Anesthesia mumps is a localized inflammatory response without systemic viral symptoms 1
- Imaging (CT) can demonstrate parotid enlargement and extent of pharyngeal involvement in anesthesia mumps 1
Postoperative Monitoring Protocol
Maintain heightened surveillance for at least 2-4 hours post-extubation, watching specifically for:
- Progressive facial or neck swelling
- Stridor or respiratory distress
- Difficulty swallowing or managing secretions
- Changes in voice quality
Have emergency airway equipment immediately available including video laryngoscope, endotracheal tubes, and surgical airway supplies 1.