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Case Reports
. 2020 Jul-Sep;14(3):390-393.
doi: 10.4103/sja.SJA_782_19. Epub 2020 May 30.

C-arm fluoroscopy for tracheal intubation in a patient with severe cervical spine pathology

Yukihide Koyama  1 , Koichi Tsuzaki  1 , Kazuo Ohmori  2 , Koichiro Ono  2 , Takeshi Suzuki  3
Affiliations
Case Reports

C-arm fluoroscopy for tracheal intubation in a patient with severe cervical spine pathology

Yukihide Koyama et al. Saudi J Anaesth. 2020 Jul-Sep.

Abstract

Tracheal intubation is challenging in patients with severe cervical spine pathology. In such cases, awake fiberoptic intubation is the gold standard and safest option for tracheal intubation. However, this technique requires the patient's understanding and cooperation, and therefore, may be contraindicated in patients with refusal or poor tolerance. Herein, we report successful orotracheal intubation in a patient with limited mouth opening and severe cervical spine rigidity under general anesthesia using an extraglottic airway device and a gum-elastic bougie under C-arm fluoroscopic guidance.

Keywords: C-arm fluoroscopic guidance; severe cervical spine pathology; tracheal intubation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
These four photographs show anesthesia induction procedures over time in this case. Photographs (a, b, c, and d) represent preoxygenation with nasopharyngeal oxygen insufflation in the position with head elevated, Proseal® laryngeal mask airway (PLMA) inserted in the patient, a gum-elastic bougie inserted in the trachea via PLMA, and the 7.0-mm Parker-Flex-Tip® tracheal tube inserted in the trachea over the gum-elastic bougie, respectively. A 14-Fr nasopharyngeal catheter was inserted to insufflate oxygen at 5 L/min. Note that the patient's head and neck positions were maintained throughout the procedure
Figure 2
Figure 2
Photographs (a and b) show C-arm fluoroscopic images of the patient's airway and cervical spine from the lateral view during tracheal intubation, respectively. PLMA, Proseal® laryngeal mask airway; GEB, gum-elastic bougie
See this image and copyright information in PMC

References

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