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The Rigid Tube as an Alternative in Controlling the Problematic Airway
Published on: June 6, 2020
Difficult airway in advanced Bechterew's disease: case report
Zdenko Novotny1, Aleksandra Gvozdenović, Branka Maldini
1Department of Anesthesiology, Resuscitation and Intensive Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia. zdenko.novotny@kbcsm.hr
Acta Clinica Croatica
|January 22, 2013
Summary
Advanced Bechterew's disease can complicate airway management due to spinal ossification. This case highlights a successful alternative intubation technique when initial methods fail in patients with severe cervical spine rigidity.
Area of Science:
- Anesthesiology
- Orthopedics
- Pulmonology
Background:
- Advanced Bechterew's disease (ankylosing spondylitis) leads to progressive spinal ossification, impacting airway management.
- Cervical spine rigidity in advanced Bechterew's disease poses significant challenges for endotracheal intubation.
- Standard intubation techniques may be difficult or impossible due to limited neck mobility.
Observation:
- A 77-year-old male with advanced Bechterew's disease was scheduled for elective hernioplasty.
- Initial intubation attempt using awake fiberoptic nasal intubation, per the Mainz algorithm, failed due to nasal deformity.
- Mask ventilation was confirmed to be feasible prior to proceeding.
Findings:
- General anesthesia was induced after the failure of awake intubation.
- A Bonfils rigid fiberscope was successfully employed for endotracheal intubation on the first attempt.
- This demonstrates an effective alternative strategy for challenging airways.
Implications:
- The Bonfils rigid fiberscope can be a valuable tool for intubation in patients with Bechterew's disease and difficult airway anatomy.
- Anesthesiologists should consider alternative devices when standard intubation protocols are unsuccessful.
- Case reports like this contribute to refining airway management algorithms for complex orthopedic conditions.
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