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RGUHS Nat. J. Pub. Heal. Sci Vol: 14  Issue: 2 eISSN:  pISSN

Original Article

Penetrating injury to nape of the neck: “modified supine” position for patient positioning and airway management.

Vijayalakshmi B.C. *, Srinivas V.Y. **, Gurudatta C.L. ***, Sumalatha A.****,

* Assistant Professor, ** Associate Professor, *** Professor and Head, ****Postgraduate Department of Anaesthesiology, Mysore Medical College & Research Institute, Mysore, Karnataka

 

Corresponding author:

Dr C L Gurudatta Professor and Head of the Department of Anaesthesiology Mysore Medical College & Research Institute Mysore Dattguru55@gmail.com

Year: 2015, Volume: 5, Issue: 1, Page no. 9-12,
Views: 543, Downloads: 2
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CC BY NC 4.0 ICON
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0.
Abstract

Anaesthetic management of the patients who present with a penetrating protruding foreign body from the nape of the neck is a real challenge, as it is very difficult to secure the airway in supine position. The technique used must guarantee maximal stability of the cervical spine to avoid any further neurological impairment. Endotracheal Intubation using fibre optic bronchoscope which is considered the gold standard may not be available in many institutions. Intubation in lateral position or use of Laryngeal Mask Airway in prone posture can be tried, but will be difficult and risky. Additional problem in an emergency patient is the full stomach. We present a case of 55 year old male patient with a metal rod protruding 10 centimeters from the nape of neck posted for emergency removal. A “modified supine” method of patient positioning was tried which allowed direct laryngoscopy and awake intubation in supine position with manual in lay stabilization thereby, providing a safer and cost effective alternative.

<p>Anaesthetic management of the patients who present with a penetrating protruding foreign body from the nape of the neck is a real challenge, as it is very difficult to secure the airway in supine position. The technique used must guarantee maximal stability of the cervical spine to avoid any further neurological impairment. Endotracheal Intubation using fibre optic bronchoscope which is considered the gold standard may not be available in many institutions. Intubation in lateral position or use of Laryngeal Mask Airway in prone posture can be tried, but will be difficult and risky. Additional problem in an emergency patient is the full stomach. We present a case of 55 year old male patient with a metal rod protruding 10 centimeters from the nape of neck posted for emergency removal. A &ldquo;modified supine&rdquo; method of patient positioning was tried which allowed direct laryngoscopy and awake intubation in supine position with manual in lay stabilization thereby, providing a safer and cost effective alternative.</p>
Keywords
patient positioning, awake intubation, penetrating injury to neck, manual in lay stabilization.
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