Pentax-airway scope for tracheal intubation breaks through the limitation of neck motion in an ankylosing spondylitis patient wearing halo vest--a case report

Emergency Tracheal Intubation in an Ankylosing Spondylitis Patient in a Sitting Position Using an Airway Scope Combined with Face-to-Face and Digital Intubation

BACKGROUND

Emergency intubation in a patient with advanced ankylosing spondylitis (AS) who presents with severe thoracic kyphosis deformity, rigid cervical flexion deformity of the neck, and an inability to achieve the supine position is particularly challenging to emergency physicians.

CASE REPORT

This study reports on an AS patient presenting with these difficult airway characteristics and acute respiratory failure who was successfully intubated using video laryngoscope-assisted inverse intubation (II) and blind digital intubation (BDI). By using Pentax AirwayScope-assisted inverse intubation, the tracheal tube tip was passed through the glottic opening, but an unexpected resistance occurred during tube advancement, which was overcome by subsequent BDI. By using laryngoscope-assisted II complemented by the BDI technique, the patient was successfully intubated without complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our case demonstrated that these two emergency airway management techniques are valuable backup methods and complement each other when applied to certain unstable airways, especially when the traditional patient position is not easily accomplished. Unexpected difficulty is not rare during airway management; emergency physicians should always be well prepared both mentally and practically.

Nasotracheal Intubation: An Overview

INTRODUCTION

Nasotracheal intubation is the commonest method used to induce anaesthesia in oral surgery patients. It has a distinct advantage of providing good accessibility for oral surgical procedures.

ANATOMY AND PROCEDURE

One must know the anatomy involved, the pathway and procedure of intubation, the pre-anaesthetic medication and complications which may be seen at the time of intubation. The surgeon must have the knowhow of the tube and the procedure which are explained in detail in the article.

COMPLICATIONS

Several complications can arise while performing the procedure which may be operator induced or arising due to anatomical variations.

CONCLUSION

It is prudent for the oral surgeon to know the basics of nasotracheal intubation in order to form a useful team member for management of complications arising from anaesthesia. Recent years have seen improvement in the armamentarium. These help negate the blindness of the procedure.