Predictive underestimation of difficult direct laryngoscopy in a patient with rheumatoid arthritis-associated immobilized craniocervical junction.

IF 0.8 Q3 ANESTHESIOLOGY JA Clinical Reports Pub Date : 2023-12-05 DOI:10.1186/s40981-023-00679-9

Hirotaka Matsuyama, Masato Hara, Atsushi Seto, Teruyuki Hiraki

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Abstract

Background: The upper cervical spine is a major focus of damage by rheumatoid arthritis (RA). Specific screening for mobility of the upper cervical spine, which is essential for direct laryngoscopy, is lacking. Herein, we present a case of RA with Cormack-Lehane grade IV, which was not predicted by preoperative examination.

Case presentation: A 66-year-old woman with RA was scheduled for a right total knee arthroplasty and right elbow synovectomy. She had a long history of RA without symptoms related to the cervical spine or spinal cord. Although physical examination suggested moderate risk of difficult intubation with preserved cervical retroflexion, her Cormack-Lehane classification was grade IV under muscle relaxation. Bony integration of the occiput to axis was considered to be the main cause of difficult direct laryngoscopy, and restricted neck rotation was found postoperatively.

Conclusions: RA patients may have limited upper cervical spine motion despite normal cervical retroflexion.

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类风湿性关节炎相关颅颈交界处固定患者直接喉镜检查困难的预测性低估。

背景：上颈椎是类风湿性关节炎（RA）的主要损害部位。上颈椎的活动度对直接喉镜检查至关重要，但目前还缺乏对上颈椎活动度的专门筛查。在此，我们介绍了一例 Cormack-Lehane 分级 IV 的 RA 病例，术前检查并未预测到这一情况：一名 66 岁的女性 RA 患者计划接受右全膝关节置换术和右肘滑膜切除术。她有长期的 RA 病史，但没有与颈椎或脊髓相关的症状。虽然体格检查提示她在保留颈椎后屈的情况下有中度插管困难的风险，但她的Cormack-Lehane分级在肌肉松弛状态下为IV级。枕骨与轴的骨性结合被认为是直接喉镜检查困难的主要原因，术后发现颈部旋转受限：结论：尽管颈椎后屈正常，但RA患者的上颈椎活动可能受限。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JA Clinical Reports ANESTHESIOLOGY-

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

9 weeks

期刊介绍： JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.