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GENERAL ARTICLES

Unanticipated Difficult Endotracheal Intubations in Patients with Cervical Spine Instrumentation

Kai O. Schoenhage, MD^*, and Heidi M. Koenig, MD

*Department of Anesthesiology, University of Illinois at Chicago; and Department of Anesthesiology and Perioperative Medicine, University of Louisville, Kentucky

Address correspondence and reprint requests to Heidi M. Koenig, MD, Department of Anesthesiology and Perioperative Medicine, University of Louisville, 530 South Jackson St., Room C2A03, Louisville, KY 40202. Address e-mail to heidi.koenig{at}louisville.edu.

We present two cases of unanticipated difficult airway in patients requiring reoperation after cervical spine instrumentation. In both cases, the upper airway examination was normal, and fiberoptic-guided intubation proceeded with the patient sedated and breathing spontaneously. Cord visualization was difficult, but the scope was eventually advanced into the trachea and the endotracheal tube placed safely. Later review of radiographs showed the previously unrecognized protrusion of cervical hardware into the meso- and hypopharynx. We recommend that anesthesiologists review recent radiographic studies for potential airway compromise before approaching the airway of patients presenting for revision of cervical instrumentation.

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