ABSTRACT

A 23-year-old male patient with cervico-occipital fixator was scheduled for surgery due to injuries to the right forearm. The patient’s thyromental distance was 5 cm, mouth opening grade II, sternomental distance 10 cm and Mallampati score 4. The loss of extension of the neck in particular indicated difficult intubation. Anaesthetic procedures are almost always difficult in patients with cervico-occipital fixators; the limited cervical extension complicates both intubation and ventilation. In this report, application of general anaesthesia using awake fibre-optic bronchoscopic intubation (FOB) is described. After routine monitoring of vital signs and premedication, hypopharyngeal topical anaesthesia was applied with 10% lidocaine sprayed twice via the appropriate nostril. Superior laryngeal nerve block was performed with local anaesthetic infiltration of tissues 1 cm below the hyoid bone. Lingual and pharyngeal branches of the glossopharyngeal nerve were blocked. Transtracheal block was performed. Following completion of local anaesthesia, the patient, who was oxygenated with 5 L min-1 of 100% O2 , was intubated using the awake FOB technique. After muscle relaxation, the patient underwent a microsurgical operation to repair eight tendons, one artery, and one nerve. Surgery lasted for 5 hours. When the extubation criteria were met, the patient was extubated. In cases of cervico-occipital fixation, which causes severe limitation of neck movements, the use of awake fibre-optic intubation should be considered.

Keywords: Cervico-occipital fixation, fibre-optic bronchoscope, awake intubation, difficult intubation, loss of extension of neck