Anesthetic management of a patient in prone position with a drill bit penetrating the spinal canal at C1-C2, using a laryngeal mask.
Airway management in patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. A 19-yr-old patient was brought to the emergency room in prone position with a drill bit protruding from the posterolateral aspect of his neck. The bit had entered the spinal canal below the first cervical vertebra, and placed near the odontoid peg. He was referred for surgical removal of the drill. The use of an inhaled induction of anesthesia, avoiding muscle relaxants, and ventilation through a laryngeal mask airway inserted in the prone position seemed to offer a satisfactory approach.


CONCLUSIONS
Management of patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. Anesthesia may be induced and the airway can be managed with the patient already in the prone position for surgery.
Valero
Ricard
R
Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain. rvalero@medicina.ub.es
Serrano
Silvia
S
Adalia
Ramón
R
Tercero
Javier
J
Blasi
Annabel
A
Sánchez-Etayo
Gerard
G
Martínez
Gloria
G
Caral
Lluis
L
Ibáñez
Guillermo
G
D000059:Accidents; D000328:Adult; D000769:Anesthesia, Inhalation; D002533:Cerebral Angiography; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D019838:Neck Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016684:Prone Position; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery