Bangalore medical college and Research Institute, India
Title: Difficult airway with difficult regional anaesthesia for lower limb surgeries-Anaesthetic concerns.
Biography: Swetha Rajoli
Difficult airway remains the greatest challenge faced during administration of anaesthesia on a day to day basis. Maintaining a patent airway is essential for adequate oxygenation and ventilation and failure to do so can be life threatening. We, as anaesthesiologists, are sometimes caught in a dilemma of choice of anaesthesia in diificult airway patients and feel comfortable by giving regional anaesthesia.
We report a case of 65 year old male, who had develpoed PTRA 18 years back posted for SSG. Pre-anaesthetic examination showed no history of neck and back stiffness, backache., but on examination patient had MPT Grade-3,restricted neck extension, fluorosis of oral cavity and narrow IVS. Spinal anaesthesia in L3-L4 IVS using 23G spinal needle in sitting position, median approach was attempted multiple times, LP was attempted in other lumbar IVS using median approach which was unsuccessful. Paramedian approach was attempted in lumbar IVS multiple times, but could finally get in L3-L4 IVS. Inj. Bupivacaine Heavy 2.5%CC given. Patient was put in supine position and level of block assessed.
Though the plan of anaesthesia was regional technique. Difficult intubation cart, fibre-optic technique for difficult intubation was arranged priorly in case of failure of regional anaesthesia/local anaesthetic toxicity/high or total spinal anaesthesia.