Successful Lightwand-Guided Intubation in a Patient with Long Standing Ankylosing Spondylitis Who Had Failed Intubation with Other Intubation Tools
Woo Jong Shin,
Jong Hoon Yeom, Woo Jae Jeon, Jae Hang Shim, Min Jae Cho, Sang Yun Cho*
Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Republic of Korea
*Corresponding author: Sang Yun Cho, Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Republic of Korea. Tel: +82315602400; Fax: +82315631731; Email: chosy@hanyang.ac.kr
Received Date:
16 April, 2018; Accepted Date: 25 April,
2018; Published Date: 02 May, 2018
Citation: Shin WJ, Yeom JH, Jeon WJ, Shim JH, Cho MJ, et al. (2018) Successful Lightwand-Guided Intubation in a Patient with Long Standing Ankylosing Spondylitis Who Had Failed Intubation with Other Intubation Tools. Anesth Med Pract J: AMPJ-127. DOI: 10.29011/AMPJ-127. 100027
1. Abstract
Tracheal intubation in patients with cervical arthroplasty with occlusion of the upper airway frequently poses great difficulty. The purpose of this case study was to discuss lightwand tracheal intubation in patients with ankylosing spondylitis (AS) through exploring a successful lightwand-guided intubation case of a patient with AS. The patient was a 61-year-old male suffering from a fixed extension-flexion deformity that affected mobility in his entire spine. Any methods including GlideScope, I-gel were failed. Tracheal intubation using lightwand was only successful. Based on this case, we would like to suggest that using a lightwand in cases of AS may be appropriate.
2.
Keywords: Ankylosing Spondylitis; Lightwand
Ankylosing Spondylitis (AS) is a chronic, progressive, and autoimmune spondyloarthropathy. AS is a disease that starts with the sacroiliac joint and the spine, causes inflammation of the entire spine, ultimately resulting in the fusion of all vertebral bodies (bamboo spine). [1] The stiffness of the cervical spine and atlantooccipital, temporomandibular, and cricoarytenoid joints caused by AS can cause great difficulty during intubation. Patients who have had chronic AS for a long time may have severe whole spine kyphosis, which makes it impossible for the patient to be positioned properly for normal intubation, because the patient cannot adequately extend their neck [2].
In many studies, a lightwand has proven to be useful for intubation in patients who are unable to extend their neck. [3-5] The purpose of this study was to investigate a case of a successful intubation using a lightwand in an AS patient. Written consent was obtained from patient.
AS occurs in 1% of the male population and 0.5% of the female population (in Caucasians). In males, it is the most common at the age of 20-30 and invades the spine and pelvic joints more often than in females [5]. The cause of the disease is not known, and environmental factors (bacterial or viral agents) are thought to be susceptible to diseases (HLA-B27) and gender, age, and ethnicity [2].
In this case, we attempted intubation after induction of general anesthesia rather than awake intubation because patient refused awake fiber optic intubation and wanted general anesthesia. Because face mask ventilation during preoxygenation was well maintained, the patient’s situation was not a CICO situation, and other intubation tools could be used after the first failed attempt without waking the patient.
Airway management in AS patients poses many difficulties for anesthesiologists. The rigidity of the joints due to the arthroplasty of the cervical vertebrae and the resulting limited neck extension is not only a great threat to intubation but also increases the risk of cervical fracture during neck manipulation for intubation. According to these limitations, the safest method for intubation is awake fiber optic intubation, but in this case the position of the patient is fixed to the supine (the circuit does not need to move unstably). I-gel supraglottic airway #3 insertion was first attempted because the patient’s mouth opening and the patency of the airway were good. After this attempt failed, the view of the glottis through the GlideScope did not show any possibility for intubation at all, and the lightwand, a tool for intubation regardless of mouth opening or glottis view, was used.
Figure
1: Supine positon of
patient. Large pillows under the head and neck were placed to support a neutral
position.
Figure
2: Radiological
findings with diffuse marginal syndesmophytosis and arthritis
of both facet joints of the lumbar spine.