Bilateral guided cervical block for Zenker diverticulum excision in a patient with ankylosing spondylitis.
Patients with severe ankylosing spondylitis (AS) have difficulties in tracheal intubation. An 87-year-old man with severe AS was scheduled for Zenker diverticulum (ZD) excision. It was decided to proceed with combined bilateral cervical plexus blockade using a nerve stimulator. The surgery lasted about 3 h, with stable hemodynamics, ECG, and oxygen saturation. The use of a nerve stimulator-guided cervical block minimizes the risk of severe respiratory and/or airway compromise secondary to phrenic nerve or recurrent laryngeal nerve palsy, because it can elicit diaphragmatic muscle response, which helps to avoid the administration of local anesthetic directly to the area of the phrenic nerve, and guides correct needle placement. In conclusion, the nerve stimulatorguided bilateral cervical block in our ZD patient with AS was shown to be a safe and successful alternative anesthetic option.
Naja
Zoher M
ZM
Department of Anesthesia and Pain Medicine, Makassed General Hospital, 11072210, Beirut, Lebanon.
Al-Tannir
Mohamad A
MA
Zeidan
Ahed
A
Oweidat
Mustafa
M
El-Rajab
Mariam
M
Ziade
Fouad M
FM
Baraka
Anis S
AS
D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D004558:Electric Stimulation; D004562:Electrocardiography; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D009407:Nerve Block; D010100:Oxygen / Q000097:blood; D011859:Radiography; D013167:Spondylitis, Ankylosing / Q000150:complications*; D016672:Zenker Diverticulum / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*
D000779:Anesthetics, Local; D010100:Oxygen