Sugammadex use in difficult intubation due to ankylosing spondylitis and severe restrictive respiratory disease

Year 2012, Volume: 3 Issue: 3, 398 - 400, 01.09.2012

Yakup Tomak Habib Bostan Başar Erdivanlı Ahmet Şen

https://doi.org/10.5799/ahinjs.01.2012.03.0187

Abstract

Bu yazıda, torasik spinal rekonstrüksiyon operasyonu planlanan, ankilozan spondilite bağlı ağır restriktif akciğer hastalığı ve zor entübasyon bulguları gösteren 50 yaşında erkek hastanın anestezi yönetimi tartışıldı. Torakal deformite nedeniyle hastanın baş ekstansiyonu kısıtlı, supin pozisyonda uyuma ve nefes almada zorluk çekiyor. Ağız açıklığında ve baş ekstansiyonundaki kısıtlılık nedeniyle hasta larengeal maske kullanılarak entübe edildi. Bronşiyal sekresyonlarda artış ve bronkospazmı önlemek, solunum kaslarının fonksiyonunu optimum düzeyde geri döndürmek için sugammadex uygulamasını takiben ekstübe edildi.

Keywords

Restriktif akciğer hastalığı, havayolu yönetimi, larengeal maske, sugammadex, ankilozan spondilit

Sugammadex use in difficult intubation due to ankylosing spondylitis and severe restrictive respiratory disease

Abstract

We describe anesthesia management of a 50-year-old man scheduled for thoracic spinal reconstruction, presenting with severe restrictive respiratory disease and difficult airway due to ankylosing spondilitis. The patient was unable to extend his head, had difficulty in breathing and sleeping in supine position due to thoracal deformities. The patient was intubated using intubating laryngeal mask airway to overcome the difficulties of limited mouth opening and head extension. He was extubated following administration of sugammadex to obtain optimal conditions in terms of respiratory muscle function and to prevent hypersecretion and bronchospasm.

Keywords

Restrictive lung disease, airway management, laryngeal masks, sugammadex, ankylosing spondylitis

References

• Woodward LJ, Kam PC. Ankylosing spondylitis: recent developments and anaesthetic implications. Anesthe- sia 2009; 64(5): 540-8.
• Benimof JL. Management of the difficult airway. With special emphasis on awake intubation. Anesthesiol- ogy 1991; 75(9): 1087-110.
• Raval C, Patel H, Patel P, Kharod U. Retrograde intu- bation in a case of ankylosing spondylitis posted for correction of deformity of spine. Saudi J Anesth 2010; 4(1): 38-41.
• Hoh DJ, Khoueir P, Wang MY. Management of cervical deformity in ankylosing spondylitis. Neurosurg Focus 2008; 24(1): E9.
• Kumar CM, Mehta M. Ankylosing spondylitis: lateral approach to spinal anesthesia for lower limb surgery. Can J Anaesth 1995; 42(1): 73-6.
• Sivrikaya GU, Hanci A, Dobrucali H, Yalcinkaya A. Ce- sarean section under spinal anesthesia in a patient with ankylosing spondylitis-a case report. Middle East J Anesthesiol 2010; 20(6): 865-8.
• Dougados M, Dijkmans B, Khan M,et al. Conventional treatments for ankylosing spondylitis. Ann Rheum Dis 2002; 61(3): 40-50.
• Radford EP, Doll R, Smith PG. Mortality among patients with ankylosing spondylitis not given X-ray therapy. N Engl J Med 1977; 297(11): 572-6.
• Lu PP, Brimacombe J, Ho AC, Shyr MH, Liu HP. The intubating laryngeal mask airway in severe ankylosing spondylitis. Can J Anaesth 2001; 48(10): 1015-9.
• Osmer C, Vogele C, Zickmann B, Hempelmann G. Comparative use of muscle relaxants and their rever- sal in three European countries: a survey in France, Germany and Great Britain. Eur J Anaesthesiol 1996; 13(4): 389-99.
• van Vlymen JM, Parlow JL. The effects of reversal of neuromuscular blockade on autonomic control in the perioperative period. Anesth Analg 1997; 84(1): 148- 54.
• Booij LH, de Boer HD, van Egmond J. Reversal agents for nondepolarizing neuromuscular blockade: reasons for and development of a new concept. Sem Anesthesia Periop Med Pain 2002; 21(1): 92-8.
• de Boer HD, van Egmond J, van de Pol F, Bom A, Booij LH. Chemical encapsulation of rocuronium by synthetic cyclodextrin derivatives: reversal of neuro- muscular block in anaesthetized Rhesus monkeys. Br J Anaesth 2006; 96(2): 201-6.
• Günay H, Başağan E, Kaya F, et al. Comparison of the efficacy of dexmedetomidine and esmolol in the treatment of increased hemodynamic response dur- ing the recovery period. J Clin Exp Invest 2012; 3(1): 53-60.
• Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsu- lation of rocuronium bromide by a cyclodextrin-based synthetic host. Angew Chem Int Ed Engl 2002; 41(3): 266-70.