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NEUROSURGICAL ANESTHESIOLOGY AND NEUROSCIENCE

Emergency Airway Management with Fiberoptic Intubation in the Prone Position with a Fixed Flexed Neck

From the Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Address correspondence and reprint requests to Tzong-Shiun Lee, MD, Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung-San South Road, Taipei, Taiwan. Address e-mail to tslee{at}ntu.edu.tw.

Abstract

We describe emergency airway management with fiberoptic intubation in a patient in the prone position with her neck flexed by a head pin holder during a neurosurgical procedure. Laryngeal mask airway is suggested in emergency difficult airway algorithms; however, this was not feasible in this patient because of her edematous upper airway and limited mouth opening resulting from extreme neck flexion by a head pin holder. The case illustrates the role of fiberoptic intubation in emergency airway management in this critical situation. Maneuvers to facilitate fiberoptic technique are also described.