Awake Fiberoptic Intubation in a Patient with Cervical Fractures: A Case Report

Abstract

Awake fiberoptic intubation is a critical aspect of managing the airway in patients with cervical fractures and preventing secondary spinal cord injury. This technique is particularly important in cases of severe cervical stenosis, unstable fractures, and limited mouth opening. This case report evaluates the efficacy and safety of awake fiberoptic intubation in a 29-year-old male with multiple cervical fractures from a vehicle collision. The patient underwent successful awake fiberoptic intubation using the Spray-As-You-Go technique with remifentanil sedation, followed by uneventful surgery. The literature supports awake fiberoptic intubation as the gold standard for maintaining cervical stability and ensuring patient comfort. Future research should focus on refining these techniques, exploring new technologies, and establishing standardized protocols to improve airway management in cervical fracture cases.

Keywords

• Awake
• fiberoptic
• intubation
• cervical

References

1. Cabrini L, Baiardo Redaelli M, Filippini M, Fominskiy E, Pasin L, Pintaudi M, Plumari VP, Putzu A, Votta CD, Pallanch O, Ball L, Landoni G, Pelosi P, Zangrillo A. Tracheal intubation in patients at risk for cervical spinal cord injury: A systematic review. Acta Anaesthesiol Scand. 2020 Apr;64(4):443-454. doi: 10.1111/aas.13532. Epub 2019 Dec 27. PMID: 31837227.
2. Chatrath, V., Sharan, R., Jain, P., Bala, A., & Ranjana, .. (2016). The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation. Anesthesia Essays and Researches, 10(2), 255. https://doi. org/10.4103/0259-1162.171443.
3. Cheng, T., Wang, L., Wang, H., Yang, X., Zhang, X., & Liang, J. (2020). Shikani optical stylet for awake nasal intubation in patients undergoing head and neck surgery. The Laryngoscope, 131(2), 319-325. https://doi. org/10.1002/lary.2876.
4. Kaur S, Chawla D, Kumar P, et al. To evaluate the comparison of intubating conditions using fentanyl plus propofol versus nalbuphine plus propofol during fiberoptic intubation. J. Evolution Med. Dent. Sci. 2018;7(51):5430- 5436, DOI: 10.14260/jemds/2018/1202.
5. Knudsen, K., Nilsson, U., Högman, M., & Pöder, U. (2015). Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study. BMC Anesthesiology, 16(1). https://doi. org/10.1186/s12871-016-0240-z.
6. Kumar N, Bindra A, Mahajan C, Yadav N. Airway management in a patient of ankylosing spondylitis with traumatic cervical spine injury. Saudi J Anaesth. 2015 Jul-Sep;9(3):327-9. doi: 10.4103/1658-354X.154741. PMID: 26240557; PMCID: PMC4478831.
7. Madziala M, Smereka J, Dabrowski M, Leung S, Ruetzler K, Szarpak L. A comparison of McGrath MAC® and standard direct laryngoscopy in simulated immobilized cervical spine pediatric intubation: a manikin study. Eur J Pediatr. 2017 Jun;176(6):779-786. doi: 10.1007/s00431-017-2909-9. Epub 2017 Apr 21. PMID: 28429117; PMCID: PMC5432598.
8. Murugesan, K. and P, R. (2018). Comparison between dexmedetomidine and a combination of midazolam and fentanyl for sedation during awake fiberoptic intubation - a prospective randomized parallel group double- blinded study. Journal of Evolution of Medical and Dental Sciences, 7(42), 4560-4565. https://doi.org/10.14260/jemds/2018/1017.

9. Niyogi, S., Basak, S., Acharjee, A., & Chakraborty, I. (2017). Efficacy of intravenous dexmedetomidine on patient's satisfaction, comfort and sedation during awake fibre-optic intubation in patients with cervical spondylotic myelopathy posted for elective cervical fixation. Indian Journal of Anaesthesia, 61(2), 137. https://doi.org/10.4103/0019-5049.199856.