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CRITICAL CARE AND TRAUMA

Anesthetic Management of a Patient in Prone Position with a Drill Bit Penetrating the Spinal Canal at C1-C2, Using a Laryngeal Mask

Ricard Valero, MD PhD^*, Silvia Serrano, MD^*, Ramón Adalia, MD^*, Javier Tercero, MD^*, Annabel Blasi, MD^*, Gerard Sánchez-Etayo, MD^*, Gloria Martínez, MD^*, Lluis Caral, MD, and Guillermo Ibáñez, MD

Departments of *Anesthesiology and Neurosurgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain

Address correspondence and reprint requests to Ricard Valero, MD, PhD, Anesthesiology Department, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. Address e-mail to rvalero{at}medicina.ub.es

Airway management in patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. A 19-yr-old patient was brought to the emergency room in prone position with a drill bit protruding from the posterolateral aspect of his neck. The bit had entered the spinal canal below the first cervical vertebra, and placed near the odontoid peg. He was referred for surgical removal of the drill. The use of an inhaled induction of anesthesia, avoiding muscle relaxants, and ventilation through a laryngeal mask airway inserted in the prone position seemed to offer a satisfactory approach.

IMPLICATIONS: Management of patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. Anesthesia may be induced and the airway can be managed with the patient already in the prone position for surgery.

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