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Jurisic, Ivo; Milic, Morena; Smiljanic, Iva; Brundula, Ana; Laus, Perislav; Jurisic, Vesna; Brzica, Kristina Jurisic
Acta clinica Croatica (Tisak), 03/2023, Letnik: 62, Številka: S1Journal Article
SCIWOCTET is a cervical spine injury (CSI) with objective signs of myelopathy, due to trauma, without evidence of ligament injury or bone fractures on x-ray and computed tomography (CT) images. It is rare, found in about 3% of patients with CSI. Perioperative manipulation of these patients may cause secondary spinal cord injury. The challenge for the anesthesiologist is to manage an airway with as little movement of the patient's head and neck as possible. A patient is presented after a fall from a motorbike. At hospital admission, he had neurological defcit in the innervation area of the cervical spinal cord. Multi-slice CT of the head and cervical spine was without signs of acute bone trauma. Magnetic resonance imaging was performed and the diagnosis met the criteria defining SCIWOCTET. Elective cervical spine surgery under general anesthesia was performed, the patient was intubated with a rigid bronchoscope using manual in-line immobilization. The selection of instruments and procedures is emphasized. Other procedures, techniques and instruments that can be used for airway management and their influence on the movement of the patient's head and neck are listed. It is concluded that rigid bronchoscopy with the application of manual in-line immobilization is suitable for emergency and elective intubation of patients with cervical spine pathology. Key words: Anesthesia; Cervical spinal cord injury; SCIWOCTET; Airway; Rigid bronchoscope; Bonfls SCIWOCTET je ozljeda vratne kraljeznice s objektivnim znakovima mijelopatije uslijed traume, bez dokaza ozljede ligamenata ili prijeloma kostiju na prikazima rtg i kompjutorizirane tomografje (CT). Navedena ozljeda je rijetka, nadena je kod 3% bolesnika s ozljedom vratne kraljeznice. Svako postupanje s ovim bolesnicima moze izazvati sekundarnu ozljedu kraljeznicne mozdine. Izazov za anesteziologa je zbrinjavanje disnoga puta, uz sto manji pomak glave i vrata bolesnika. Prikazuje se bolesnik nakon tupe ozljede uslijed pada s motora. Kod prijma Glasgowska ljestvica kome (GCS) bila 15, uz neuroloski ispad iz inervacijskog podrucja vratne kraljeznicne mozdine. Multi-slice CT glave i vratne kraljeznice nije pokazala znakova akutne kostane traume. Naknadno je ucinjena magnetska rezonanca, a dijagnoza je ispunjavala kriterije koji definiraju SCIWOCTET. Na bolesniku je izvedena elektivna kirurgija vratne kraljeznice u opcoj anesteziji. Intubiran je rigidnim bronhoskopom uz primjenu manualne in-line imobilizacije (MILI). Poslijeoperacijski dolazi do poboljsanja neuroloskog defcita. U prikazu slucaja naglasen je odabir instrumenata i postupaka (rigidni bronhoskop uz MILI), u cilju sto manjeg pomicanja glave i vratne kraljeznice bolesnika. Navedeni su drugi postupci, tehnike i instrumenti koje je moguce rabiti za zbrinjavanje disnoga puta i njihov utjecaj na pomak glave i vrata bolesnika. Moze se zakljuciti da je rigidna bronhoskopija uz MILI prikladna za hitnu i elektivnu intubaciju bolesnika s patologijom vratne kraljeznice. Kljucne rijeci: Anestezija; Ozljeda vratne kraljeznice; SCIWOCTET; Disni put; Rigidni bronhoskop; Bonfls
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