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  • Title: Congenital cervical spine fusion and airway management: a case series of Klippel-Feil syndrome.
    Author: Stallmer ML, Vanaharam V, Mashour GA.
    Journal: J Clin Anesth; 2008 Sep; 20(6):447-51. PubMed ID: 18929286.
    Abstract:
    STUDY OBJECTIVE: To determine the ideal airway management modalities in general anesthesia for pediatric patients with Klippel-Feil syndrome, a disorder that is characterized by abnormalities of the cervical spine and craniofacial structures that may impede successful airway management. DESIGN: Retrospective review of electronic anesthesia database. SETTING: University hospital. MEASUREMENTS: The electronic charts of 10 pediatric patients with Klippel-Feil syndrome (KFS) who received treatment at our institution from 2005 to 2007 were reviewed with a focus on diagnosis, level of lesion, comorbid diseases, age, procedure, history of perioperative difficulties, and airway management during general anesthesia. MAIN RESULTS: A total of 10 pediatric patients, 6 girls and 4 boys, underwent 11 procedures from 2005 to 2007. Average age was 11 (range, 4-16 yrs). Six patients were ASA physical status II and 4 were ASA physical status III. Four patients had spinal fusion, 6 underwent magnetic resonance imaging, and one patient underwent removal of halo hardware. Eight patients had undergone previous surgeries; of the 8, one patient had a history of difficult intubation. Six patients underwent tracheal intubations, 4 had a Laryngeal Mask Airway (LMA; Orthovent Intafix, Maidenhead, UK) placed, and one had mask ventilation with an oral airway. Of 6 tracheal intubations, 5 were achieved on the first or second attempt without difficulty. Three had grade 1 laryngoscopic views; only one patient needed fiberoptic intubation. Because the fiberoptic intubation took several attempts, it was noted as a difficult intubation in the chart. All LMAs were placed without difficulty, and the cases were uneventful. CONCLUSIONS: The airways of individuals with KFS may be successfully managed in a variety of ways, often with little degree of difficulty.
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