title: Awake tracheal intubation through the intubating laryngeal mask airway in a patient with halo traction.
abstract: OBJECTIVE
  To report a case of awake tracheal intubation through the intubating laryngeal mask airway (ILMA) in a patient with halo traction.
  
  
  METHODS
  A 16-yr-old, 40 kg, boy with atlanto-occipital instability and halo traction was scheduled for surgery under general anesthesia. The head of the patient was fixed in a position of flexion and extension was impossible. Cranial magnetic resonance imaging revealed that pharyngeal and laryngeal axes were aligned, but that the oral axis was in an extreme divergent plane. The tongue and oropharynx were anesthetized with 10% lidocaine spray and bilateral superior laryngeal nerve blockade was performed. Under sedation, awake orotracheal intubation via ILMA was successful. Fibreoptic bronchoscopy has been recommended for awake tracheal intubation in such patients. Other techniques, such as use of the Bullard laryngoscope have been described also but awake tracheal intubation through the ILMA in patients with a halo device in situ has seldom been reported in the medical literature.
  
  
  CONCLUSIONS
  Airway management of patients with cervical spine instability includes adequate preoperative evaluation of the airway and choosing the appropriate intubation technique. We suggest that the ILMA may be an adequate alternative for awake tracheal intubation in patients with an unstable cervical spine and cervical immobilization with a halo device.
authors.affiliation: Department of Anesthesiology and Reanimation, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey. bengimd@hotmail.com
authors.forename: Elif Bengi
authors.initials: EB
authors.lastname: Sener
authors.forename: Binnur
authors.initials: B
authors.lastname: Sarihasan
authors.forename: Emre
authors.initials: E
authors.lastname: Ustun
authors.forename: Serhat
authors.initials: S
authors.lastname: Kocamanoglu
authors.forename: Ebru
authors.initials: E
authors.lastname: Kelsaka
authors.forename: Ayla
authors.initials: A
authors.lastname: Tur
mesh_terms: D000768:Anesthesia, General; D001268:Atlanto-Axial Joint / Q000293:injuries / Q000601:surgery*; D001999:Bronchoscopy; D006801:Humans; D007103:Immobilization; D007442:Intubation, Intratracheal / Q000379:methods*; D007593:Joint Instability / Q000150:complications* / Q000601:surgery; D017214:Laryngeal Masks; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D014143:Traction / Q000295:instrumentation*