AIRWAY CHALLENGES IN A ANKYLOSING SPONDYLITIC PATIENT WITHTRAUMATIC CERVICAL SPINE FRACTURE - A CASE REPORT

Sateesh Kumar J., Raj Murugan, Krishnagopal Vinod, Akash Yadhav
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Abstract

Background:Ankylosing Spondylitis (AS) is a chronic inflammatory condition that results in the fusion of the spine and decreased flexibility, commonly known as bamboo spine. This condition presents significant challenges to anesthesiologists due to potential difficulties in managing the airway, cardiovascular issues, and compromised respiration. AS patients face an increased risk of fractures and spinal cord injury, especially in the cervical spine, which is prone to instability and higher morbidity and mortality rates. Maneuvers to manage the airway and intubation techniques may exacerbate movement in the cervical spine, potentially leading to further injury. Case Report: A 42-year-old man with a history of AS presented with a cervical spine injury after a road traffic accident. MRI showed fractures at the posterior arch of C1 and C4-C5 levels with nerve root compression. The patient, who was not regularly followed up, was taking medication. Preoperative assessment revealed a potentially difficult airway, and the patient had quadriparesis and reduced sensation. Due to the risk of spinal cord injury, an awake fiberoptic intubation (AFOI) was planned. The AFOI was successfully performed through the nasal route, and the patient underwent a C4-C5 discectomy and stabilization. The postoperative recovery was uneventful, with no new neurological deficits. Discussion: The case emphasizes the need to minimize movement of the cervical spine when managing the airway in AS patients with cervical spine fractures. Using AFOI is more effective than other techniques in this scenario, as it minimizes cervical movement and allows for post-intubation neurologic assessments. Although the glidescope video laryngoscope and intubating laryngeal mask airway are considered as alternatives to direct laryngoscopy, anesthesiologists still prefer AFOI as the primary option. Conclusion: This case report demonstrates the best airway management for an AS patient with a cervical spine fracture, with a focus on the role of the anesthesiologist in preventing further injury and neurologic deterioration. Awake fiberoptic intubation is the safest alternative for AS patients with cervical spine fractures, as long as the anesthesiologist has the requisite skills and knowledge.
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强直性脊柱炎患者合并颈椎骨折时的气道难题--病例报告
背景:强直性脊柱炎(AS)是一种慢性炎症,会导致脊柱融合和灵活性降低,俗称竹节病。由于气道管理、心血管问题和呼吸受损等潜在困难,这种疾病给麻醉医生带来了巨大挑战。强直性脊柱炎患者骨折和脊髓损伤的风险增加,尤其是颈椎,因为颈椎容易不稳定,发病率和死亡率较高。管理气道的操作和插管技术可能会加剧颈椎的运动,从而可能导致进一步的损伤。病例报告:一名有强直性脊柱炎病史的 42 岁男子在一次道路交通事故后颈椎受伤。核磁共振成像显示,C1 和 C4-C5 后弓骨折,神经根受压。患者没有定期随访,一直在服药。术前评估显示气道可能有困难,患者四肢瘫痪,感觉减退。由于存在脊髓损伤的风险,因此计划进行清醒纤支镜插管(AFOI)。通过鼻腔途径成功进行了纤支镜插管,并为患者进行了C4-C5椎间盘切除术和稳定术。术后恢复顺利,没有出现新的神经功能障碍。讨论:该病例强调,在对颈椎骨折的 AS 患者进行气道管理时,需要尽量减少颈椎的移动。在这种情况下,使用 AFOI 比其他技术更有效,因为它可以最大限度地减少颈椎的移动,并允许在插管后进行神经评估。尽管 glidescope 视频喉镜和喉罩气道插管被认为是直接喉镜检查的替代方法,但麻醉医师仍倾向于将 AFOI 作为主要选择。结论:本病例报告展示了对颈椎骨折的强直性脊柱炎患者的最佳气道管理方法,重点是麻醉医师在防止进一步损伤和神经功能恶化方面的作用。对于颈椎骨折的 AS 患者来说,只要麻醉医师具备必要的技能和知识,清醒状态下的纤支镜插管是最安全的选择。
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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