Anesthetic Management of a Patient in Prone Position with a Drill Bit Penetrating the Spinal Canal at C1-C2, Using a Laryngeal Mask

Valero, Ricard; Serrano, Silvia Fernandez; Adàlia, R.; Tercero, Javier; Blasi, Annabel; Sánchez‐Etayo, G.; Martínez, Gloria; Caral, L.; Ibáñez, Guillermo

doi:10.1213/01.ane.0000111102.52964.7f

Cited by 32 publications

(27 citation statements)

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“…The prone position impairs orotracheal intubation by direct laryngoscopy, particularly when the patient's head is positioned on the operating table [4]. Moving the patient's body close to the head of the operating table, and freeing the patient's head and shoulders (as demonstrated in our patient), might facilitate access to the patient's airway (oropharynx).…”

Section: Discussionmentioning

confidence: 81%

“…Although awake fi beroptic intubation of the trachea is probably the "gold standard" [2,[4][5][6] of airway instrumentation in patients with posterior thoracic/cervical trauma (and it was our fi rst-choice technique for this patient), this technique requires the patient's cooperation, special equipment, and extensive training [4,5], all of which might be diffi cult to accomplish in emergency situations (as proven in our report). The stress of the trauma alone (thoracic spine injury) combined with the patient's negative attitude towards awake management of her airway (and subsequent lack of cooperation) contributed to the failure of the fi rst trial of awake intubation.…”

Section: Discussionmentioning

confidence: 84%

“…However, such management might not be applicable to trauma patients presenting with posterior thoracic or cervical spine injuries [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…If airway manipulation in the prone position is indicated, it can be anticipated that this position might increase the risk of diffi cult ventilation and cervical/ thoracic spine injury [4,5]. The prone position impairs orotracheal intubation by direct laryngoscopy, particularly when the patient's head is positioned on the operating table [4].…”

Section: Discussionmentioning

confidence: 99%

“…

Case report

A 43-year-old, 166-cm, 65-kg, previously healthy woman (a hospital employee) was suddenly attacked by a psychiatric ward patient with a pair of scissors.

…”

mentioning

confidence: 99%

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Direct laryngoscopy and endotracheal intubation in the prone position following traumatic thoracic spine injury

et al. 2008

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incidence of diffi cult ventilation, diffi cult airway instrumentation, and cervical/thoracic spine injury [4][5][6][7][8]. We herein present the fi rst reported case of an adult trauma patient who underwent direct laryngoscopy and endotracheal intubation under general anesthesia in the prone position. Case reportA 43-year-old, 166-cm, 65-kg, previously healthy woman (a hospital employee) was suddenly attacked by a psychiatric ward patient with a pair of scissors. One of the scissor blades was inserted 8 cm deep into the middle region of her upper back/posterior upper thorax. The patient was immediately immobilized on a "spine board" in the prone position ( Fig. 1) and transferred to a neighboring trauma center for further care.Upon arrival at the trauma center, she was conscious, and hemodynamically stable, and was breathing spontaneously. Her neurological examination was unremarkable. Thoracic radiographic studies and a computerized tomography scan (both conducted in the prone position) ruled out pneumothorax and established the exact position of the scissors' blade (between the processi spinosi, in close proximity to the spinal cord at the T7 level, with the blade's tip lodged 2 cm into the corpus of the T7 vertebra; Fig. 2). No traumatic fracture/s of the corpus of the vertebra could be demonstrated, nor was there any indication of thoracic spinal dura mater penetration.The patient was transferred to the operating theater. As the trauma surgeon did not want to move the patient (to avoid possible neurological compromise) the anesthesia team decided to establish the airway (intubate the patient's trachea) in the prone position. It was determined that the patient had had nothing per os (NPO) for more than 5 h. Her airway examination was normal (Mallampati class one), and she had a good mouth Abstract Perioperative airway management in trauma victims presenting with penetrating thoracic spine injury poses a major challenge to the anesthesiologist. To avoid further neurological impairment it is essential to ensure maximal cervical and thoracic spine stability at the time of airway manipulation (e.g., direct laryngoscopy and endotracheal intubation). Airway management in the prone position additionally increases the incidence of cervical/thoracic spine injury, diffi cult ventilation, and diffi cult airway instrumentation. Although awake fi beroptic intubation of the trachea is considered the gold standard for airway instrumentation in patients with posterior thoracic/ cervical trauma, this technique requires the patient's cooperation, special equipment, and extensive training, all of which might be diffi cult to accomplish in emergency situations. We herein present the fi rst reported case of an adult trauma patient who underwent direct laryngoscopy and endotracheal intubation under general anesthesia in the prone position. Although the prone position is not the standard position for airway instrumentation with direct laryngoscopy and endotracheal intubation under general anesthesia, our experience indicates that ...

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 84%

“…However, such management might not be applicable to trauma patients presenting with posterior thoracic or cervical spine injuries [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…

Case report

A 43-year-old, 166-cm, 65-kg, previously healthy woman (a hospital employee) was suddenly attacked by a psychiatric ward patient with a pair of scissors.

…”

mentioning

confidence: 99%

See 3 more Smart Citations