phenylephrine-hydrochloride and Spondylitis--Ankylosing

The establishment of lung isolation is often particularly challenging for the anesthesiologist in patients with difficult airway. Usually, orotracheal intubation with double lumen tube is the commonly used technique for achieving 1 lung anesthesia. Whereas, in patients with limited mouth opening and restricted cervical mobility, this technique becomes extremely difficult and hazardous. We report a case in which bronchial blocker placement was succeeded via both nostrils in a difficult airway due to restricted mouth opening.. A 50-year-old, non-smoking female with a painless mass in the left upper lobe. She had a 10-year history of ankylosing spondylitis and squamous cell carcinoma of the floor of the mouth after 5 operations 4 years previously.. Left upper lobe adenocarcinoma, ankylosing spondylitis and oral squamous cell carcinoma.. To achieve 1 lung anesthesia, both nostrils were used for extraluminal bronchial blocker placement.. Initially, oral intubation was selected for establishing a patent airway but failed. Then switched to nasal canal for insertion, after several attempts, a conventional nasal intubation tube (internal diameter 6.0 mm) was placed via 1 nostril under topical anesthesia, with the aid of a flexible fiberoptic bronchoscope, and a bronchial blocker was advanced to the desired position via the other nostril.. In difficult airway with limited mouth opening and restricted cervical mobility, multidisciplinary experts participated discussion is a prerequisite for contemplating a scientific plan. Preoperative computed tomography scan and 3-dimensional computed tomography reconstruction would be helpful in detecting the narrowest part of airway conduit and determining a safe, reliable, and feasible airway program.

Topics: Adenocarcinoma of Lung; Airway Obstruction; Carcinoma, Squamous Cell; Female; Humans; Intubation; Lung Neoplasms; Middle Aged; Mouth; Mouth Neoplasms; Nose; One-Lung Ventilation; Spondylitis, Ankylosing

Object The goal of the study was to report a series of consecutive patients who underwent endoscopic transnasal odontoidectomy (ETO) without resection of nasal turbinates. The techniques for this minimally invasive approach are described in detail. Methods The authors conducted a retrospective review of consecutive patients who underwent ETO for basilar invagination. All the patients had myelopathy caused by compression at the cervicomedullary junction, which required surgical decompression. Preoperative and postoperative data, including those from radiographic and clinical evaluations, were compared. Morbidity and mortality rates for the procedure are also reported in detail. Results Thirteen patients (6 men and 7 women) with a mean age of 52.7 years (range 24-72 years) were enrolled. The basilar invagination etiologies were rheumatoid arthritis (n = 5), trauma (n = 4), os odontoideum (n = 2), ankylosing spondylitis (n = 1), and postinfectious deformity (n = 1). The average follow-up duration was 51.2 months (range 0.3-105 months). One patient died 10 days after the operation as a result of meningitis caused by CSF leakage. Among the other 12 patients, the average postoperative Nurick grade (3.2) was significantly improved over that before the operation (4.1, p = 0.004). The mean (± SD) duration of postoperative intubation was 1.5 ± 2.1 days, and there was no need for perioperative tracheostomy or nasogastric tube feeding. There also was no postoperative velopharyngeal insufficiency. There were 6 (46%) intraoperative and 2 (15%) postoperative CSF leaks in the 13 patients in this series. Conclusions ETO is a viable and effective option for decompression at the ventral cervicomedullary junction. This approach is minimally invasive and causes little velopharyngeal insufficiency. The pitfall of this approach is the difficulty in repairing dural defects and subsequent CSF leakage.

Topics: Adult; Aged; Arthritis, Rheumatoid; Decompression, Surgical; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Odontoid Process; Retrospective Studies; Spinal Fractures; Spondylitis, Ankylosing; Tomography, X-Ray Computed; Treatment Outcome; Turbinates; Young Adult

Several techniques of airway management in ankylosing spondylitis (AS) have been reported. No study related specifically to the use of a lightwand-assisted intubation in AS has been previously described. The present case report demonstrates that an awake, nasotracheal intubation can be successfully performed to provide general anesthesia in a patient with AS. A 65-year-old Thai male was scheduled for exploratory surgery under general anesthesia. Past medical history consisted of hypertension and AS. The preoperative airway assessment showed limitation of mouth opening, an extremely anteriorly flexed and immobile cervical spine. An awake intubation under sedation and topical airway anesthesia were chosen. Multiple attempts at blind nasotracheal intubation and oral approach with lightwand were unsuccessful. Finally, intubation was successfully performed with lightwand by nasal route. This serves to show that an awake nasotracheal intubation with a lightwand may be a safe and useful alternative option for airway management in patients with severe ankylosing spondylitis.

Topics: Aged; Anesthesia, General; Conscious Sedation; Humans; Intubation, Intratracheal; Male; Nose; Spondylitis, Ankylosing