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LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1461-1462

“Cervical Chondrosarcoma” a Difficult Airway Managed with Awake CMAC VLS Aided Intubation


Department of Neuro Anaesthesiology, Academic SR, NIMHANS, Bangalore, Hosur Road, Bengaluru, Karnataka, India

Date of Web Publication30-Oct-2021

Correspondence Address:
Prashanth A Menon
Academic SR, NIMHANS Bangalore, Hosur Road, Bengaluru - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329585

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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

How to cite this URL:
Menon PA. “Cervical Chondrosarcoma” a Difficult Airway Managed with Awake CMAC VLS Aided Intubation. Neurol India [serial online] 2021 [cited 2021 Nov 30];69:1461-2. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1461/329585




Sir,

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.
Figure 1: Original MRI sagittal T1 and T2 weighed images

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Chondrosarcomas with cervical spine involvement are relatively rare.[1] These tumors are locally aggressive with a limited potential of metastasis. Total excision is a treatment of choice.[2] 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.[3] 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.[4] 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.



 
  References Top

1.
Merchant S, Mohiyuddin SM, Rudrappa S, Deo RP, A S, Menon LR. Cervical chondrosarcoma- rare malignancy: A case report. Indian J Surg Oncol 2014; 54:293-6.  Back to cited text no. 1
    
2.
Strike SA, McCarthy EF. Chondrosarcoma of the spine: A series of 16 cases and a review of the literature. Iowa Orthop J 2011;31:154-9.  Back to cited text no. 2
    
3.
Asai T, Shingu K. Difficulty in advancing a tracheal tube over a fibreoptic bronchoscope: Incidence, causes and solutions (Review). Br J Anaesth 2004;92:870-81.  Back to cited text no. 3
    
4.
McGuire BE. Use of the McGrath videolaryngoscope in awake patients. Anaesthesia 2009;64:912-4.  Back to cited text no. 4
    


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