Anesth Pain Med.  2018 Oct;13(4):383-387. 10.17085/apm.2018.13.4.383.

Awake fiberoptic orotracheal intubation using a modified Guedel airway in a patient with craniocervical instability and an anticipated difficult airway: A case report

• Choi Y
• Woo SW
• Lee JH

• KMID: 2435995
• DOI: http://doi.org/10.17085/apm.2018.13.4.383

Abstract

In patients with upper cervical instability, airway management may provoke subluxation of the craniocervical region and neurologic injury, and can be challenging for the anesthesiologist. Endotracheal intubation using a fiberoptic bronchoscope is frequently used in these patients to minimize spine motion, but this procedure may fail in patients with altered airway anatomy. When fiberoptic endotracheal intubation fails in these patients, optional intubation methods are limited. We describe successful awake fiberoptic orotracheal intubation using a modified Guedel airway divided in the midline for a 59-year-old man with an anticipated difficult airway, due to limited mouth opening, a nasopharyngeal tumor, and craniocervical spine instability after failure of conventional fiberoptic orotracheal intubation.

Keyword

Airway; Bronchoscope; Guedel airway; Instability; Neck

MeSH Terms

Airway Management
Bronchoscopes
Humans
Intubation*
Intubation, Intratracheal
Middle Aged
Mouth
Neck
Spine

Figure

• 

  Fig. 1 Magnetic resonance imaging of the patient’s cervical spine, demonstrating skull base and C1 and C2 radiation necrosis with C1-2 instability, recurrent cancer in the nasopharynx, and narrowing of the central canal at C1 level.

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  Fig. 2 Modified Guedel airway cut in midline and fixed with silicone tape; the tape had more regular slits at the midline than original tape by making a few slits (A) and was easily divided by light traction (B).

Reference

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