Fiberoptic intubation in 327 neurosurgical patients with lesions of the cervical spine

Chondrosarcoma is the tumor which affects bone and soft tissue with only 2% spinal involvement. Anesthetic management becomes challenging in patients with cervical chondrosarcoma. Here, we are presenting a case of huge neck mass due to cervical spine chondrosarcoma in 70 year old male hypertensive patient. The patient has distorted anatomy with mucosal edema with left tracheal deviation and compression from right side. Awake Nasal Fiberoptic intubation was done with cuffed ETT no 8. The neck mass was removed and Anterior Cervical Discectomy and Fusion (ACDF) with bone grafting. The case was managed with adequate analgesia, replacement of fluids and Blood and Blood products. Considering complex cervical spine surgery and airway edema the patient was shifted to Surgical Intensive Care Unit (ICU) for elective ventilation and advanced monitoring. After serial ABG and proper weaning the patient was extubated next morning smoothly. Extensive preoperative evaluation, planning, clinical judgement and skilled experienced personale are essential for proper execution of difficult airway cases.

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Comparative Study Between Dexmedetomidine and Fentanyl as Sedatives in Awake Fiberoptic Intubation in Cervical Spine Surgeries

QJM ◽

10.1093/qjmed/hcab086.033 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Waleed Mohamed Abd El Mageed ◽

Ahmad Kamal Mohamed Ali ◽

Eeman Aboubakr ElSiddik Ahmed Bayoumi ◽

Haitham Sabry Mahmoud Omar

Keyword(s):

Cervical Spine ◽

Sedation Score ◽

Fiberoptic Intubation ◽

Intubation Time ◽

Hemodynamic Stability ◽

Double Blind ◽

Hemodynamic Variables ◽

Group A ◽

Group B ◽

Awake Fiberoptic Intubation

Abstract Background Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them have various side effects. Aim The aim of this study was to compare the effects of dexmedetomedine and fentanyl as regards sedative effects, hemodynamic stability, intubation time and intubation attempts success during awake fiberoptic intubation. Material and Methods A randomized double-blind prospective study was conducted on a total of 40 patients scheduled for elective cervical spine surgeries who were randomly allocated into two equal groups (n 20): (group A) patients received a bolus dose of dexmedetomidine of 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. and fentanyl group (group B) received dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/hr. Sedation score (Ramsy sedation score), hemodynamic variables, oxygen saturation, intubation time and intubation attempts were noted and compared between the two groups. Results Ramsy Sedation Score was significantly favorable (P < 0.001) in group A in comparison to group B, moreover better hemodynamic stability during intubation (P < 0.05) and less intubation attempts were observed in group A in comparison to group B. Conclusion The results of our study showed that dexmedetomidine provides optimum sedation without compromising airway or hemodynamic stability and with favorable intubation time and less intubation attempts during AFOI in comparison to fentanyl.

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Common Neurosurgical Procedures

Medical Management of Neurosurgical Patients ◽

10.1093/med/9780190913779.003.0001 ◽

2019 ◽

pp. 1-15

Author(s):

Kevin Hines ◽

Stavropoula Tjoumakaris ◽

Pascal M. Jabbour ◽

Robert H. Rosenwasser ◽

M. Reid Gooch

Keyword(s):

Cervical Spine ◽

Lumbar Spine ◽

Adverse Events ◽

Medical Management ◽

Neurosurgical Procedures ◽

Ventriculoperitoneal Shunting ◽

Neurosurgical Patient ◽

Neurosurgical Patients

Medical management of the neurosurgical patient can be complicated. These patients may suffer from a difficult neurosurgical pathology while still living with challenging comorbidities. As a result, this population often requires cooperation between multiple teams including neurosurgeons, neurologists, neurointensivists, and hospitalists. In this chapter, the authors review common neurosurgical procedures that the neurohospitalist encounters, including ventriculoperitoneal shunting, craniotomy and craniectomy, cervical spine decompression with or without fusion, lumbar spine decompression and/or fusion, and cerebral angiograms. The authors aim to highlight the methodology, indications, and issues of perioperative medical management. Understanding these procedures is vital to minimizing adverse events and providing the best possible care for neurosurgical patients.

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