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|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 5 | Page : 1461-1462
“Cervical Chondrosarcoma” a Difficult Airway Managed with Awake CMAC VLS Aided Intubation
Prashanth A Menon
Department of Neuro Anaesthesiology, Academic SR, NIMHANS, Bangalore, Hosur Road, Bengaluru, Karnataka, India
|Date of Web Publication||30-Oct-2021|
Prashanth A Menon
Academic SR, NIMHANS Bangalore, Hosur Road, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Menon PA. “Cervical Chondrosarcoma” a Difficult Airway Managed with Awake CMAC VLS Aided Intubation. Neurol India 2021;69:1461-2
A 45-year-old female patient was presented with complaints of neck pain radiating till the upper limbs, progressive weakness of all four limbs, and dysphagia. The MRI showed T2 hyperintense and T1 hypointense lesions compressing the cervical cord posteriorly and projecting anteriorly encroaching the hypopharynx [Figure 1]. A diagnosis of chondrosarcoma was made after the FNAC. The patient was posted for elective resection of the tumor along with fusion of the cervical spine by a combined anterior and posterior approach. In view of the tumor encroaching the airway, above the laryngeal inlet, wake intubation was planned with the provision of a surgical tracheostomy, in the event of an intubation failure. On the day of surgery, the patient was premedicated with intravenous glycopyrrolate 0.2 mg. Topical airway anesthesia was provided in the form of 4% xylocaine nebulization and 10% xylocaine spray. Oxygen was supplemented through a nasal cannula at 2 L/min. Gentle laryngoscopy was performed with CMAC videolaryngoscope (VLS) and vocal cords were visualized. The airway was secured with 7.5 sizes cuffed ET tube after spraying the vocal cords with 10% xylocaine spray. Anesthesia was induced after confirming the tube position. The surgery was uneventful. The patient had a good neurological recovery and was discharged with grade 5 motor power in all the four limbs.
Chondrosarcomas with cervical spine involvement are relatively rare. These tumors are locally aggressive with a limited potential of metastasis. Total excision is a treatment of choice. There are not many case reports that describe cervical chondrosarcoma presenting as difficult airway. In this case, a videolaryngoscope was chosen over a fibre optic laryngoscope, considering the possibility of injury to the tumor projecting into the hypopharynx during blind insertion of the tracheal tube with a fibre optic bronchoscope. In addition, CMAC proved to be an effective alternative to flexible fibre optic laryngoscope. Video laryngoscopes are not the preferred device for awake intubation, however, several case reports and case series have described their utility in awake intubation. The advantage of the video laryngoscope over a flexible fibre scope seems to be a direct visualisation of the insertion tube. CMAC videolaryngoscope may be a reasonable option in selected cases of awake intubation in patients with head and neck tumors obstructing the upper airway.
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Conflicts of interest
There are no conflicts of interest.
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