Fiberoptic bronchoscopy versus video laryngoscopy guided intubation in patients with craniovertebral junction instability: A cinefluroscopic comparison

Agrawal, Swati; Salunke, Pravin; Gupta, Shailesh Kumar; Swain, Amlan; Jangra, Kiran; Panda, Nidhi; Sahu, Suman; Gupta, V.; Bloria, Summit Dev; Kataria, Ketan; Bhagat, Hemant

doi:10.25259/sni_522_2020

Cited by 4 publications

(4 citation statements)

References 30 publications

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“…This has been seen to offer a similar advantage to fiberoptic intubation under general anesthesia in terms of spinal kinematics in craniovertebral junction anomalies/instability. 5 …”

Section: Discussionmentioning

confidence: 99%

A Rare Neurological Presentation of Noonan Syndrome and Its Management—A Case Report

Mahajan,

Narayanan,

Narayan

et al. 2024

Asian J Neurosurg

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Although Noonan syndrome is a relatively common congenital disorder with autosomal dominant inheritance, its association with cerebrovascular anomalies is rare. We report a case of a 20-year-old with Noonan syndrome with cerebrovascular aneurysm, who underwent successful endovascular coiling. Only four cases of cerebrovascular aneurysms in Noonan syndrome have been reported in the literature so far. To the best of our knowledge, this is only the fifth reported case and the first one that has been treated successfully with endovascular coiling. We hereby discuss the management of this case, which had several comorbidities like congenital heart disease and craniovertebral junction anomaly.

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“…This has been seen to offer a similar advantage to fiberoptic intubation under general anesthesia in terms of spinal kinematics in craniovertebral junction anomalies/instability. 5 …”

Section: Discussionmentioning

confidence: 99%

A Rare Neurological Presentation of Noonan Syndrome and Its Management—A Case Report

Mahajan,

Narayanan,

Narayan

et al. 2024

Asian J Neurosurg

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“…However, studies are yet to prove if these movements are favorable or unfavorable. A study conducted by Agrawal et al 40 has compared videolaryngoscopes with fiberoptic bronchoscopy in patients with craniovertebral junction instability. They have observed that the patients intubated with videolaryngoscopy have shown a greater increase in the upper spinal canal diameter when compared with FOB.…”

Section: Aerodynamics Of C-spine During Intubationmentioning

confidence: 99%

Airway management pearls in cervical spine disorders

Jangra

Rath

2023

International Anesthesiology Clinics

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Cervical spine (C-spine) pathologies that can cause compression on the spinal cord include acute trauma, congenital, and inflammatory disorders. The most important goal in managing a patient with C-spine pathology is to prevent further insult or aggravation of spinal cord injury. Even though the evidence is weak, manipulations of the head and neck during airway management of patients with C-spine pathology have been implicated in neurological deterioration. [1][2][3][4][5][6][7][8][9] The "sniffing position," used during intubation with direct laryngoscopy (DL), aligns the oral, oropharyngeal, and laryngeal axis. To attain this position, the lower C-spine is flexed, and extension occurs at the occipitalatlantoaxial (OAA) complex. In unstable C-spine pathology, such manipulations may result in displacement or subluxation of the bony elements, which may aggravate spinal cord compression and injuries.Neurological deterioration may occur due to the natural course of C-spine disease, surgical manipulation, and hemodynamic derangements. When managing the airway, the anesthesiologist's role is mostly to limit C-spine movements during intubation. The recent literature shows that using modern intubation equipment and techniques makes it easy and safe to intubate patients with C-spine pathology.Knowledge of the relevant anatomy, biomechanics, various pathologies affecting the C-spine, and the assessment of C-spine stability is important for anesthesia providers. This review covers, in brief, all these relevant aspects and focuses on current literature on various intubation techniques. Clinical anatomy of the C-spineBoth bony and ligamentous structures contribute to the stability of the spine. Perioperative physicians should know about these elements to identify the unstable C-spine. The foramina transversaria, through which the vertebral arteries pass, is a core structure of the cervical vertebra. Of 7 cervical vertebrae, the first, second, and seventh vertebrae are atypical, while the third to sixth are typical vertebrae. The upper 2 cervical vertebrae are anatomically and functionally different from the lower 5. These structures will be discussed separately.

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“…Other airway devices have also been successfully used in patients with restricted or confined C-spine injuries, including supraglottic airway devices, gum elastic bougies, and rigid endoscopes [ 14 , 15 , 16 ]. Flexible fiberoptic laryngoscopes and/or bronchoscopes remained as the gold standard for suspected or confirmed C-spine injuries for many years [ 17 , 18 , 19 , 20 , 21 ]. The pros and cons of the available airway management tools for patients with a potential cervical spine injury have been reviewed [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

The Use of the Shikani Video-Assisted Intubating Stylet Technique in Patients with Restricted Neck Mobility

Shih

Koay

et al. 2022

Healthcare

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Among all the proposed predictors of difficult intubation defined by the intubation difficulty scale, head and neck movement (motility) stands out and plays as a crucial factor in determining the success rate and the degree of ease on endotracheal intubation. Aside from other airway tools (e.g., supraglottic airway devices), optical devices have been developed and applied for more than two decades and have shown their superiority to conventional direct laryngoscopes in many clinical scenarios and settings. Although awake/asleep flexible fiberoptic bronchoscopy is still the gold standard in patients with unstable cervical spines immobilized with a rigid cervical collar or a halo neck brace, videolaryngoscopy has been repeatedly demonstrated to be advantageous. In this brief report, for the first time, we present our clinical experience on the routine use of the Shikani video-assisted intubating stylet technique in patients with traumatic cervical spine injuries immobilized with a cervical stabilizer and in a patient with a stereotactic headframe for neurosurgery. Some trouble-shooting strategies for this technique are discussed. This paper demonstrates that the video-assisted intubating stylet technique is an acceptable alternative airway management method in patients with restricted or confined neck motility.

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Fiberoptic bronchoscopy versus video laryngoscopy guided intubation in patients with craniovertebral junction instability: A cinefluroscopic comparison

Cited by 4 publications

References 30 publications

A Rare Neurological Presentation of Noonan Syndrome and Its Management—A Case Report

A Rare Neurological Presentation of Noonan Syndrome and Its Management—A Case Report

Airway management pearls in cervical spine disorders

The Use of the Shikani Video-Assisted Intubating Stylet Technique in Patients with Restricted Neck Mobility

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