Awake fiberoptic intubation for cesarean section in a

Chang Gung Med J · May 2003

Case Reports

Awake fiberoptic intubation for cesarean section in a parturient with odontoid fracture and atlantoaxial subluxation.

We report on the anesthetic experience of a 38-week pregnant patient in labor with an upper cervical spinal cord injury after an unusual trauma. She was transferred from a district hospital to our medical center with acute quadriplegia and sensory loss. Plain cervical spine x-ray and computed tomographic scan showed a C2 odontoid (dens of axis) process type II fracture and atlantoaxial (C1-C2) subluxation. ⋯ The instability of her cervical spine precluded the use of regional anesthesia; so awake nasal fiberoptic endotracheal intubation followed by general anesthesia was performed. The anesthetic course was uneventful, and the outcome of the parturient and newborn was good. We discuss our anesthetic considerations, intubation techniques and a review of the literature.

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- Shu-Yam Wong, Kit-Man Wong, An-Shine Chao, Ching-Chung Liang, and Jee-Ching Hsu.
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taipei. dw0909@cgmh.org.tw
- Chang Gung Med J. 2003 May 1;26(5):352-6.
AbstractWe report on the anesthetic experience of a 38-week pregnant patient in labor with an upper cervical spinal cord injury after an unusual trauma. She was transferred from a district hospital to our medical center with acute quadriplegia and sensory loss. Plain cervical spine x-ray and computed tomographic scan showed a C2 odontoid (dens of axis) process type II fracture and atlantoaxial (C1-C2) subluxation. Due to having regular uterine contractions and labor pain, she was scheduled for an urgent cesarean section. The instability of her cervical spine precluded the use of regional anesthesia; so awake nasal fiberoptic endotracheal intubation followed by general anesthesia was performed. The anesthetic course was uneventful, and the outcome of the parturient and newborn was good. We discuss our anesthetic considerations, intubation techniques and a review of the literature.

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Awake fiberoptic intubation for cesarean section in a parturient with odontoid fracture and atlantoaxial subluxation.

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