TY - JOUR
T1 - Intraoperative airway obstruction in a Duchenne muscular dystrophy patient
AU - Yang, Jae Hyuk
AU - Bhandarkar, Amit Wasudeo
AU - Lim, Byung Gun
AU - Modi, Hitesh N.
AU - Suh, Seung Woo
N1 - Funding Information:
Acknowledgments This study was supported by a grant from the Korea Healthcare Technology R&D project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A110416). No benefits in any form have been, or will be received from any commercial party related directly or indirectly to the subject of this manuscript.
PY - 2013/5
Y1 - 2013/5
N2 - Purpose To report a complication of airway obstruction during spinal deformity correction surgery in Duchenne muscular dystrophy (DMD) patient, due to lordoscoliosis, airway malacia, and prone surgical positioning, which was rectified by changing the position of the patient and surgery was successfully completed. Case description A 15-year-old boy was diagnosed with DMD and admitted for surgical treatment of thoracolumbar scoliosis. The patient's preoperative Cobb's angle was 79° and the kyphotic angle was -19°. During the initial period of surgery, while in the prone position, peak inspiratory pressure (PIP) suddenly increased from 20-21 to 38-41 cmH2O, wheezing sounds were heard on auscultation of both lungs, and his blood pressure began to fall. Under suspicion of airway problem, intraoperative fiberoptic bronchoscopy was performed which confirmed airway obstruction. Attributing patient's prone position as the cause of airway obstruction, the surgical position of the patient was changed from prone to semi-lateral. After this change, the PIP stabilized to within normal limits (20-23 cmH2O). The surgical correction was successfully completed with a posterior-only pedicle screw by the freehand technique, with the patient in the semi-lateral position for the rest of surgery. Conclusions Lordoscoliosis and airway malacia in a patient with DMD can lead to occlusion of the tracheobronchial lumen when the patient is in the prone position. Changing the patient's position from prone to semi-lateral can be of help to reverse this airway obstruction and complete the surgery. Pedicular screw insertion can be safely and effectively carried out in this position using freehand technique.
AB - Purpose To report a complication of airway obstruction during spinal deformity correction surgery in Duchenne muscular dystrophy (DMD) patient, due to lordoscoliosis, airway malacia, and prone surgical positioning, which was rectified by changing the position of the patient and surgery was successfully completed. Case description A 15-year-old boy was diagnosed with DMD and admitted for surgical treatment of thoracolumbar scoliosis. The patient's preoperative Cobb's angle was 79° and the kyphotic angle was -19°. During the initial period of surgery, while in the prone position, peak inspiratory pressure (PIP) suddenly increased from 20-21 to 38-41 cmH2O, wheezing sounds were heard on auscultation of both lungs, and his blood pressure began to fall. Under suspicion of airway problem, intraoperative fiberoptic bronchoscopy was performed which confirmed airway obstruction. Attributing patient's prone position as the cause of airway obstruction, the surgical position of the patient was changed from prone to semi-lateral. After this change, the PIP stabilized to within normal limits (20-23 cmH2O). The surgical correction was successfully completed with a posterior-only pedicle screw by the freehand technique, with the patient in the semi-lateral position for the rest of surgery. Conclusions Lordoscoliosis and airway malacia in a patient with DMD can lead to occlusion of the tracheobronchial lumen when the patient is in the prone position. Changing the patient's position from prone to semi-lateral can be of help to reverse this airway obstruction and complete the surgery. Pedicular screw insertion can be safely and effectively carried out in this position using freehand technique.
KW - Airway obstruction
KW - Duchenne muscular dystrophy
KW - Lordoscoliosis
KW - Spine
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U2 - 10.1007/s00586-013-2696-6
DO - 10.1007/s00586-013-2696-6
M3 - Article
C2 - 23503897
AN - SCOPUS:84891719509
VL - 22
SP - S491-S496
JO - European Spine Journal
JF - European Spine Journal
SN - 0940-6719
IS - SUPPL.3
ER -