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PATIENT SAFETY

Crisis Resource Management of the Airway in a Patient with Klippel-Feil Syndrome, Congenital Deafness, and Aortic Dissection

From the Department of Anesthesia and Critical Care, Massachusetts General Hospital, and the Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to Warren S. Sandberg, MD, PhD, Department of Anesthesia and Critical Care, Massachusetts General Hospital, 55 Fruit St., Jackson 4, Boston, MA 02114. Address e-mail to wsandberg{at}partners.org.

Abstract

Klippel-Feil syndrome is a visually arresting deformity wherein severe restriction of cervical motion predicts a difficult airway. Even minor distraction of the neck risks cervical spine or neurologic injury, so regional techniques, awake fiberoptic intubation, or awake tracheostomy are recommended anesthetic approaches. We present a case of aortic dissection in a Klippel-Feil syndrome patient for whom congenital bilateral deafness, coupled with the urgency of the surgery, mitigated against the recommended first-choice techniques. Using anesthesia crisis resource management methods, a multi-member team rehearsed predefined roles and then managed the airway via inhaled induction of anesthesia, followed by flexible fiberoptic intubation.