Congenital cervical spine fusion and airway management: a case series of Klippel-Feil syndrome.

Abstract

STUDY OBJECTIVE:

To determine the ideal airway management modalities in general anesthesia for pediatric patients with Klippel-Feil syndrome, a disorder that is characterized by abnormalities of the cervical spine and craniofacial structures that may impede successful airway management.

DESIGN:

Retrospective review of electronic anesthesia database.

SETTING:

University hospital.

MEASUREMENTS:

The electronic charts of 10 pediatric patients with Klippel-Feil syndrome (KFS) who received treatment at our institution from 2005 to 2007 were reviewed with a focus on diagnosis, level of lesion, comorbid diseases, age, procedure, history of perioperative difficulties, and airway management during general anesthesia.

MAIN RESULTS:

A total of 10 pediatric patients, 6 girls and 4 boys, underwent 11 procedures from 2005 to 2007. Average age was 11 (range, 4-16 yrs). Six patients were ASA physical status II and 4 were ASA physical status III. Four patients had spinal fusion, 6 underwent magnetic resonance imaging, and one patient underwent removal of halo hardware. Eight patients had undergone previous surgeries; of the 8, one patient had a history of difficult intubation. Six patients underwent tracheal intubations, 4 had a Laryngeal Mask Airway (LMA; Orthovent Intafix, Maidenhead, UK) placed, and one had mask ventilation with an oral airway. Of 6 tracheal intubations, 5 were achieved on the first or second attempt without difficulty. Three had grade 1 laryngoscopic views; only one patient needed fiberoptic intubation. Because the fiberoptic intubation took several attempts, it was noted as a difficult intubation in the chart. All LMAs were placed without difficulty, and the cases were uneventful.

CONCLUSIONS:

The airways of individuals with KFS may be successfully managed in a variety of ways, often with little degree of difficulty.

• Authors: Meghan L Stallmer, Vishnu Vanaharam, George A Mashour
• Journal: Journal of clinical anesthesia (J Clin Anesth) Vol. 20 Issue 6 Pg. 447-51 (Sep 2008) ISSN: 0952-8180 [Print] United States
• PMID: 18929286 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Anesthesia, General (methods)
• Cervical Vertebrae (surgery)
• Child
• Child, Preschool
• Female
• Humans
• Intubation, Intratracheal (methods)
• Klippel-Feil Syndrome (surgery)
• Male
• Retrospective Studies
• Spinal Fusion
• Treatment Outcome