Airway obstruction following cervical spine surgery: A diagn
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Airway management in postoperative period depends on clinical skills, understanding of pathophysiology and imaging modalities.Here, we describe the management of sudden airway obstruction in a patient who underwent cervical spine instrumentation.A 59-year-old male with a diagnosis of prolapsed cervical intervertebral disc underwent cervical (C3–C4, C4–C5, and C5–C6) discectomy and instrumentation. After routine induction of anaesthesia, airway was secured with a cuffed 8.5 mm endotracheal tube under direct laryngoscopy and manual in-line stabilization. Surgery was completed in 5 h with the placement of polyetheretherketone (PEEK) cage under the guidance of C-arm image intensifier. After reversal of neuromuscular blockade, trachea was extubated after confirming sustained eye opening, adequate breathing, good cough reflex, and spontaneous limb movements. Immediately after extubation, the patient had respiratory distress and inspiratory stridor. Although oxygen saturation increased to 88–90%, end-tidal carbon dioxide levels reached to 50 mmHg. After a failed attempt of intubation through LMA, lateral view cervical X-ray was carried out using C-arm image intensifier. It revealed prevertebral displacement of PEEK cage from C4–C5 intervertebral space. Meanwhile, airway was secured with the help of video laryngoscope and bougie to avoid spine movement. A reexploration and replacement of cage with plating were carried out. The patient was electively ventilated and extubated uneventfully next day in Intensive Care Unit...

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