What are the considerations for anesthesia in a patient with a history of or current mumps infection?

Anesthesia Mumps (Acute Postoperative Sialadenitis)

"Anesthesia mumps" is a rare but potentially life-threatening complication of general anesthesia characterized by acute postoperative parotid gland swelling that can cause airway compromise requiring emergent reintubation. 1

Clinical Presentation and Recognition

The condition manifests as acute parotid gland enlargement occurring in the immediate postoperative period, which can be:

• Unilateral or bilateral parotid swelling developing shortly after general anesthesia 1
• Extensive facial swelling with potential pharyngeal edema extending to the parapharyngeal space, soft palate, and uvula 1
• Significant airway narrowing that may necessitate emergent intubation 1

Critical Airway Management Considerations

The primary concern is airway compromise, which requires immediate recognition and intervention:

• Monitor for progressive swelling in the recovery room with particular attention to respiratory distress 1
• Maintain low threshold for reintubation if airway patency is threatened 1
• Perform extubation in the operating theatre rather than recovery room when feasible to allow for immediate reintubation if needed 2
• Use video laryngoscopy by the most experienced provider if reintubation becomes necessary, as distorted anatomy may complicate airway management 2

Infection Control and Differential Diagnosis

Distinguish true mumps infection from postoperative sialadenitis:

• True mumps virus infection causes systemic viral illness with parotid swelling, aseptic meningitis, encephalitis, orchitis, and pancreatitis as potential complications 3, 4, 5
• "Anesthesia mumps" is acute postoperative sialadenitis unrelated to mumps virus, despite the colloquial name 1
• Laboratory diagnosis of true mumps requires viral isolation, nucleic acid detection, or IgM antibody confirmation 3

Anesthetic Technique Modifications

When managing patients with known mumps infection requiring surgery:

• Prioritize regional anesthesia whenever clinically appropriate to avoid airway manipulation 2
• Apply maximal barrier precautions including full hand washing, sterile gloves and gown, cap, mask, and large sterile drape for neuraxial procedures 2
• Delay elective surgery in patients with active mumps infection until symptoms resolve, as mumps is highly neurotropic with CNS involvement in approximately 50% of cases 5

Postoperative Management

For patients developing postoperative parotid swelling:

• Obtain emergent CT imaging to assess extent of swelling, parotid enlargement, and degree of airway compromise 1
• Secure airway prophylactically before complete obstruction occurs, as progressive swelling can rapidly compromise the airway 1
• Maintain minimal one-meter distance between patients in recovery areas and consider isolation if infectious etiology suspected 2

Common Pitfalls to Avoid

• Do not dismiss postoperative parotid swelling as benign - this can rapidly progress to life-threatening airway obstruction 1
• Do not confuse "anesthesia mumps" with true mumps virus infection - they require different management approaches 3, 1
• Do not delay imaging or airway intervention when progressive swelling is observed 1
• Do not proceed with elective surgery in patients with active mumps due to high risk of CNS complications including aseptic meningitis and encephalitis 5, 6