Airway management options in a prone achondroplastic dwarf with a difficult airway after unintentional tracheal extubation during a wake-up test for spinal fusion

To flip or not to flip?

Lisa Sohn, Amod Sawardekar, Narasimhan Jagannathan*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To present a case of unintentional tracheal extubation in a prone positioned patient with a known difficult airway. Clinical features: This case report describes the unintended tracheal extubation of an achondroplastic dwarf with kyphosis undergoing spinal fusion and instrumentation. The patient had a history of obstructive sleep apnea and a difficult airway requiring fibreoptic-guided tracheal intubation through an air-Q™ supraglottic airway device. Abrupt head movement during a wake-up test to evaluate lost motor-evoked potential signals resulted in dislodgement of the tracheal tube. Airway obstruction was evidenced by rapid oxygen desaturation and the absence of end-tidal capnography waveforms despite apparent chest excursions. An air-Q was used for successfully rescuing the airway and quickly re-establishing oxygenation and ventilation, which eliminated the need for emergent supine positioning for airway management. The air-Q was then used as a conduit for fibreoptic-guided tracheal intubation while the patient remained in the prone position. Conclusion: This case highlights some of the safety advantages of supraglottic airway devices for airway rescue and subsequent tracheal intubation even with the patient in the prone position. The use of an air-Q may have the advantages of not requiring an intubation introducer technique and allowing for direct tracheal intubation with an appropriately sized cuffed tracheal tube.

Original languageEnglish (US)
Pages (from-to)741-744
Number of pages4
JournalCanadian Journal of Anesthesia
Volume61
Issue number8
DOIs
StatePublished - Jan 1 2014

Fingerprint

Airway Extubation
Spinal Fusion
Airway Management
Intubation
Air
Prone Position
Capnography
Motor Evoked Potentials
Equipment and Supplies
Head Movements
Kyphosis
Obstructive Sleep Apnea
Airway Obstruction
Ventilation
Thorax
Oxygen
Safety

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

@article{ef640974b92444b5acfb3ab9966baa32,
title = "Airway management options in a prone achondroplastic dwarf with a difficult airway after unintentional tracheal extubation during a wake-up test for spinal fusion: To flip or not to flip?",
abstract = "Purpose: To present a case of unintentional tracheal extubation in a prone positioned patient with a known difficult airway. Clinical features: This case report describes the unintended tracheal extubation of an achondroplastic dwarf with kyphosis undergoing spinal fusion and instrumentation. The patient had a history of obstructive sleep apnea and a difficult airway requiring fibreoptic-guided tracheal intubation through an air-Q™ supraglottic airway device. Abrupt head movement during a wake-up test to evaluate lost motor-evoked potential signals resulted in dislodgement of the tracheal tube. Airway obstruction was evidenced by rapid oxygen desaturation and the absence of end-tidal capnography waveforms despite apparent chest excursions. An air-Q was used for successfully rescuing the airway and quickly re-establishing oxygenation and ventilation, which eliminated the need for emergent supine positioning for airway management. The air-Q was then used as a conduit for fibreoptic-guided tracheal intubation while the patient remained in the prone position. Conclusion: This case highlights some of the safety advantages of supraglottic airway devices for airway rescue and subsequent tracheal intubation even with the patient in the prone position. The use of an air-Q may have the advantages of not requiring an intubation introducer technique and allowing for direct tracheal intubation with an appropriately sized cuffed tracheal tube.",
author = "Lisa Sohn and Amod Sawardekar and Narasimhan Jagannathan",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s12630-014-0182-1",
language = "English (US)",
volume = "61",
pages = "741--744",
journal = "Canadian Journal of Anaesthesia",
issn = "0832-610X",
publisher = "Canadian Anaesthetists Society",
number = "8",

}

TY - JOUR

T1 - Airway management options in a prone achondroplastic dwarf with a difficult airway after unintentional tracheal extubation during a wake-up test for spinal fusion

T2 - To flip or not to flip?

AU - Sohn, Lisa

AU - Sawardekar, Amod

AU - Jagannathan, Narasimhan

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose: To present a case of unintentional tracheal extubation in a prone positioned patient with a known difficult airway. Clinical features: This case report describes the unintended tracheal extubation of an achondroplastic dwarf with kyphosis undergoing spinal fusion and instrumentation. The patient had a history of obstructive sleep apnea and a difficult airway requiring fibreoptic-guided tracheal intubation through an air-Q™ supraglottic airway device. Abrupt head movement during a wake-up test to evaluate lost motor-evoked potential signals resulted in dislodgement of the tracheal tube. Airway obstruction was evidenced by rapid oxygen desaturation and the absence of end-tidal capnography waveforms despite apparent chest excursions. An air-Q was used for successfully rescuing the airway and quickly re-establishing oxygenation and ventilation, which eliminated the need for emergent supine positioning for airway management. The air-Q was then used as a conduit for fibreoptic-guided tracheal intubation while the patient remained in the prone position. Conclusion: This case highlights some of the safety advantages of supraglottic airway devices for airway rescue and subsequent tracheal intubation even with the patient in the prone position. The use of an air-Q may have the advantages of not requiring an intubation introducer technique and allowing for direct tracheal intubation with an appropriately sized cuffed tracheal tube.

AB - Purpose: To present a case of unintentional tracheal extubation in a prone positioned patient with a known difficult airway. Clinical features: This case report describes the unintended tracheal extubation of an achondroplastic dwarf with kyphosis undergoing spinal fusion and instrumentation. The patient had a history of obstructive sleep apnea and a difficult airway requiring fibreoptic-guided tracheal intubation through an air-Q™ supraglottic airway device. Abrupt head movement during a wake-up test to evaluate lost motor-evoked potential signals resulted in dislodgement of the tracheal tube. Airway obstruction was evidenced by rapid oxygen desaturation and the absence of end-tidal capnography waveforms despite apparent chest excursions. An air-Q was used for successfully rescuing the airway and quickly re-establishing oxygenation and ventilation, which eliminated the need for emergent supine positioning for airway management. The air-Q was then used as a conduit for fibreoptic-guided tracheal intubation while the patient remained in the prone position. Conclusion: This case highlights some of the safety advantages of supraglottic airway devices for airway rescue and subsequent tracheal intubation even with the patient in the prone position. The use of an air-Q may have the advantages of not requiring an intubation introducer technique and allowing for direct tracheal intubation with an appropriately sized cuffed tracheal tube.

UR - http://www.scopus.com/inward/record.url?scp=84904569484&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904569484&partnerID=8YFLogxK

U2 - 10.1007/s12630-014-0182-1

DO - 10.1007/s12630-014-0182-1

M3 - Article

VL - 61

SP - 741

EP - 744

JO - Canadian Journal of Anaesthesia

JF - Canadian Journal of Anaesthesia

SN - 0832-610X

IS - 8

ER -