Bilateral guided cervical block for Zenker diverticulum excision in a patient with ankylosing spondylitis

Abstract

Patients with severe ankylosing spondylitis (AS) have difficulties in tracheal intubation. An 87-year-old man with severe AS was scheduled for Zenker diverticulum (ZD) excision. It was decided to proceed with combined bilateral cervical plexus blockade using a nerve stimulator. The surgery lasted about 3 h, with stable hemodynamics, ECG, and oxygen saturation. The use of a nerve stimulator-guided cervical block minimizes the risk of severe respiratory and/or airway compromise secondary to phrenic nerve or recurrent laryngeal nerve palsy, because it can elicit diaphragmatic muscle response, which helps to avoid the administration of local anesthetic directly to the area of the phrenic nerve, and guides correct needle placement. In conclusion, the nerve stimulatorguided bilateral cervical block in our ZD patient with AS was shown to be a safe and successful alternative anesthetic option.

Anesthesia for Zenker's Diverticulectomy

“…Alternatively, the procedure can be performed under regional anesthesia using deep and superficial cervical plexus blocks (15). Regional anesthesia can decrease the risk of aspiration, by preserving protective airway reflexes.…”

Anaesthetic management of endoscopic repair of Zenker's diverticulum

“…Regional anaesthesia is also an option; a case is reported of open ZD resection under combined bilateral superficial and deep cervical plexus block, in a patient of ankylosing spondylitis with a difficult airway. [ 4 ]…”