title: Crisis resource management of the airway in a patient with Klippel-Feil syndrome, congenital deafness, and aortic dissection.
abstract: Klippel-Feil syndrome is a visually arresting deformity wherein severe restriction of cervical motion predicts a difficult airway. Even minor distraction of the neck risks cervical spine or neurologic injury, so regional techniques, awake fiberoptic intubation, or awake tracheostomy are recommended anesthetic approaches. We present a case of aortic dissection in a Klippel-Feil syndrome patient for whom congenital bilateral deafness, coupled with the urgency of the surgery, mitigated against the recommended first-choice techniques. Using anesthesia crisis resource management methods, a multi-member team rehearsed predefined roles and then managed the airway via inhaled induction of anesthesia, followed by flexible fiberoptic intubation.
authors.affiliation: Department of Anesthesia and Critical Care, Massachusetts General Hospital, and Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Khawaja
authors.forename: J Taylor
authors.initials: JT
authors.lastname: Reed
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shaefi
authors.forename: Hovig V
authors.initials: HV
authors.lastname: Chitilian
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
mesh_terms: D000328:Adult; D000465:Algorithms; D000768:Anesthesia, General / Q000523:psychology; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001794:Blood Pressure; D020680:Bronchoscopes; D001999:Bronchoscopy; D002574:Cervical Vertebrae / Q000002:abnormalities; D003638:Deafness / Q000150:complications* / Q000151:congenital; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods* / Q000523:psychology; D007714:Klippel-Feil Syndrome / Q000150:complications* / Q000473:pathology; D020704:Laryngoscopes; D007828:Laryngoscopy; D008297:Male; D016343:Monitoring, Intraoperative; D055100:Optical Fibers; D010347:Patient Care Planning; D010348:Patient Care Team; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000523:psychology