PERIOPERATIVE AIRWAY MANAGEMENT IN PATIENTS UNDERGOING SURGERY FOR RHEUMATOID-ARTHRITIS OF THE CERVICAL-SPINE

Patients with advanced rheumatoid arthritis often cause difficulties d uring induction as well as termination of anaesthesia. Since endotrach eal intubation with the conventional laryngoscope may be impossible an d even associated with a risk of injuring the cervical medulla, fibreo ptic intubation is recommended whilst the patient is awake. Extubation of the trachea may also cause difficulties due to oedema in the upper airway or pulmonary complications. One hundred and twenty-seven patie nts undergoing an occipito-cervical fusion operation due to advanced r heumatoid arthritis were investigated retrospectively. Utilizing a fib reoptic bronchoscopic technique 154 tracheal intubations were performe d in awake patients and the perioperative management of the airways re viewed. Out of 141 intubations problems were encountered in seven case s; laryngeal deviation was the cause in six and nosebleed in the seven th. Postoperatively, in 110 cases the trachea was extubated shortly af ter the operation and in an additional 32 patients within the first 24 h. Oedema of the larynx was the reason for keeping five patients intu bated for more than 24 h and pulmonary complications in another five. Other reasons for prolonged postoperative intubation were acute airway obstruction in one patient and requirement for prolonged ventilatory support due to cerebellar hemorrhage in another. Removal of the endotr acheal tube was mainly uneventful if exhalation was able to occur arou nd the deflated cuff with the endotracheal tube in situ.