AIRWAY MANAGEMENT WITH RIGID BRONCHOSCOPE IN ADULT PATIENT DURING CERVICAL SPINE SURGERY: A CASE REPORT

Abstract

SCIWOCTET is a cervical spine injury (CSI) with objective signs of myelopathy, due to trauma, without evidence of ligament injury or bone fractures on x-ray and computed tomography (CT) images. It is rare, found in about 3% of patients with CSI. Perioperative manipulation of these patients may cause secondary spinal cord injury. The challenge for the anesthesiologist is to manage an airway with as little movement of the patient's head and neck as possible. A patient is presented after a fall from a motorbike. At hospital admission, he had neurological deficit in the innervation area of the cervical spinal cord. Multi-slice CT of the head and cervical spine was without signs of acute bone trauma. Magnetic resonance imaging was performed and the diagnosis met the criteria defining SCIWOCTET. Elective cervical spine surgery under general anesthesia was performed, the patient was intubated with a rigid bronchoscope using manual in-line immobilization. The selection of instruments and procedures is emphasized. Other procedures, techniques and instruments that can be used for airway management and their influence on the movement of the patient's head and neck are listed. It is concluded that rigid bronchoscopy with the application of manual in-line immobilization is suitable for emergency and elective intubation of patients with cervical spine pathology.

Keywords: Airway; Anesthesia; Bonfils; Cervical spinal cord injury; Rigid bronchoscope; SCIWOCTET.

Fig. 1

Sagittal MSCT scans through the left and right facet joints and midsagittal view showing no subtle signs of fracture or dislocation.

Fig. 2

T2 weighted midsagittal MRI image: 1 – prevertebral hematoma; 2 – retrolisthesis of C3 on C4 with obliteration of anterior CSF space; 3 – increased signal intensity signifying contused spinal cord zone.

Fig. 3

The patient was intubated with a rigid bronchoscope (Bonfils).