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CASE REPORT: SUCCESSFUL REGIONAL ANESTHESIA FOR AWAKE FIBER OPTIC INTUBATION IN A RARE CASE OF GRISEL'S SYNDROME
Author(s): ,
Memary, E.
Affiliations:
Imam Hossein Educational Hospital, Anesthesiology, Tehran, Iran
,
Mirkheshti, A.
Affiliations:
Imam Hossein Educational Hospital, Anesthesiology, Tehran, Iran
Tabashi, S.*
Affiliations:
Imam Hossein Educational Hospital, Anesthesiology, Tehran, Iran
ESRA Academy. tabashi s. Sep 13, 2017; 190693; 166 Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
soudeh tabashi
soudeh tabashi

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Abstract
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Background and Aims:

Grisel’s syndrome is a rare disorder occurs secondary to inflammatory processes and neck surgery. It involves subluxation of atlanto-axial joint. Its presentation consist of torticollis, neck pain and stiffness, cord compression and maybe death from acute respiratory failure. In these patient tracheal intubation may be extremely difficult because of many reasons such as positioning, limited neck movement, mouth opening and unstable cervical spine.

Methods:

A 29-year-old man with Grisel's syndrome was referred to our hospital for cervical spine C1-C2 reduction and fixation. His complaint was acute onset of painful torticollis with the right rotation of head since 5 months ago. His neck extension gradually made him sleep in sitting position and was fixed anterolaterally with less than 2 fingerbreadth from right clavicle. He was scheduled for the surgery as paresthesia in hands, decreased force in all extremities and urinary incontinency was developed.

Results:

Awake nasal fiberoptic intubation with airway nerve block was planned. Glossopharyngeal, superior laryngeal nerve and transtracheal blocks were administered by admixture of lidocaine2% and dexmedetomidine. Then flexible scope intubation was performed in the awake patient. Patient was fully awake and cooperative for prone positioning.

Conclusions:

Grisel’s syndrome should be considered as difficult airway and we experienced that awake fiberoptic intubation after nerve blocks with adding dexmedetomidine to lidocaine can greatly facilitate intubation in these patients.

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