title: Upper airway obstruction associated with flexed cervical position after posterior occipitocervical fusion.
abstract: Upper airway obstruction resulting from overflexion fixation of the cervical spine is a rare but life-threatening complication after cervical spine surgery. There are few reports of dyspnea after a posterior cervical fusion. We present the case of a 63-year-old woman with rheumatoid arthritis who developed an upper airway obstruction immediately after an O-C4 fusion. She was reintubated with a fiberoptic scope. Revision surgery allowing the angle to return to the neutral position was performed to ameliorate the overflexion of the cervical spine fixation and the consequent upper airway obstruction. After revision surgery, the upper airway obstruction disappeared. Our experience suggests that intraoperative use of fluoroscopy and extubation with a tube exchanger are recommended to avoid this complication, especially in patients at high risk of upper airway obstruction.
authors.affiliation: Division of Clinical Anesthesia, Mie University Hospital, Mie, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tagawa
authors.forename: Koji
authors.initials: K
authors.lastname: Akeda
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Asanuma
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyabe
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Arisaka
authors.forename: Munetaka
authors.initials: M
authors.lastname: Furuya
authors.forename: Kazuichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Shigeki
authors.initials: S
authors.lastname: Sakuraba
mesh_terms: D000402:Airway Obstruction / Q000209:etiology* / Q000628:therapy; D000768:Anesthesia, General; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000502:physiology* / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000628:therapy; D007442:Intubation, Intratracheal; D008875:Middle Aged; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D011187:Posture; D013123:Spinal Fusion / Q000379:methods*