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CC BY 4.0 · J Neuroanaesth Crit Care 2024; 11(01): 061-063
DOI: 10.1055/s-0043-1775808
Case Report

Perioperative Challenges in Airway and Ventilatory Management of a Neurosurgical Patient with Klippel–Feil Syndrome

Geetha Lakshminarasimhaiah 
1   Department of Neuroanaesthesia and Neurocritical Care, Ramaiah Institute of Neurosciences, M. S. Ramaiah Medical College and Hospitals, Bangalore, Karnataka, India
,
Akshita Niranjan 
2   Department of Anaesthesiology, M. S. Ramaiah Medical College and Hospitals, Bangalore, Karnataka, India
,
Sonika Shivakumar
2   Department of Anaesthesiology, M. S. Ramaiah Medical College and Hospitals, Bangalore, Karnataka, India
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Abstract

Klippel–Feil syndrome, a rare congenital anomaly, has a classical triad of low posterior hairline, short neck, and restriction of neck movements. Complex airway anatomy increases the risk of neurological damage while handling the airway during positioning and laryngoscopy. We address the possible anesthetic challenges that one might face in these patients, such as difficult airway, difficult weaning from the ventilator with increased chances of reintubation, prolonged intensive care and mechanical ventilation, and difficult tracheostomy. Every anesthesiologist must be aware of the available options in the management of a difficult airway in emergent circumstances. Despite the numerous encounters, we were able to effectively manage a case of Klippel–Feil syndrome perioperatively.

Keywords

Klippel–Feil syndrome - airway management - tracheostomy - intracranial hemorrhages


Publication History

Article published online:
28 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • Reference

  • 1 Chae J, Woo J, Kim C. et al. Endotracheal intubation using McGrath videolaryngoscope in KlippelFeil syndrome. Ewha Med J 2018; 41 (04) 86-89
    CrossrefPubMedGoogle Scholar
  • 2 Chitnis A, Enohumah K. Anaesthetic challenges in a patient with Klippel–Feil syndrome scheduled for panendoscopy and biopsy. S Afr J Anaesthesiol Analg 2018; 24 (02) 60-62
    CrossrefPubMedGoogle Scholar
  • 3 Stallmer ML, Vanaharam V, Mashour GA. Congenital cervical spine fusion and airway management: a case series of Klippel-Feil syndrome. J Clin Anesth 2008; 20 (06) 447-451
    CrossrefPubMedGoogle Scholar
  • 4 Frikha R. Klippel-Feil syndrome: a review of the literature. Clin Dysmorphol 2020; 29 (01) 35-37
    CrossrefPubMedGoogle Scholar
  • 5 Shah TH, Badve MS, Olajide KO, Skorupan HM, Waters JH, Vallejo MC. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section. Clin Pract 2011; 1 (03) e57
    CrossrefPubMedGoogle Scholar
  • 6 Pavani K, Krishna HM. Klippel-Feil syndrome: interchange of plan A and B for airway management in the same patient under different circumstances. Indian J Anaesth 2017; 61 (02) 179-180
    CrossrefPubMedGoogle Scholar
  • 7 Pandian V, Hutchinson CT, Schiavi AJ. et al. Predicting the need for nonstandard tracheostomy tubes in critically ill patients. J Crit Care 2017; 37: 173-178
    CrossrefPubMedGoogle Scholar
  • 8 Walker RN, Alexander IJ, Sartorius JA, Woomert CA. Anthropometric measurements: effect of CT depth of pretracheal soft tissue on tracheotomy tube selection. AJNR Am J Neuroradiol 2012; 33 (03) 449-452
    CrossrefPubMedGoogle Scholar
  • 9 Corbett M, Hughes I, O'Shea J. et al. X-Ray and CT scan based prediction of best fit tracheostomy tube-A pilot study. Diagnostics (Basel) 2020; 10 (08) 506
    CrossrefPubMedGoogle Scholar
  • 10 Ahuja H, Mathai AS, Chander R, Mathew AE. Case of difficult tracheostomy tube insertion: a novel yet simple solution to the dilemma. Anesth Essays Res 2013; 7 (03) 402-404
    CrossrefPubMedGoogle Scholar