Management of difficult airway in Scheuermann's disease with trendelenburg position and conventional laryngoscopy

Abstract

Scheuermann's disease is a type of progressive hyperkyphosis that commonly involves lower thoracic vertebrae. Deformity is extreme and rigid due to progressive subtle changes in the vertebral endplates. Such severe form of spinal deformity leads to difficult ventilation and airway management. Strategies for approaching such an airway in a resource-limited environment by using special positioning such as the Trendelenburg position have not been reported before. A number of case reports have elaborated the successful airway management of fixed-flexion deformity with the help of supraglottic airway devices, videolaryngoscopes, fibreoptic endoscopes and surgical airways. To facilitate ventilation and intubation with laryngoscopy using the McCoy blade, the patient was placed in a supine position with wedge supportive rolls under his head, neck and upper torso. However, as this position created difficulty in approaching the airway for direct laryngoscopy, the position of the operating table was modified to 30° Trendelenburg position. This made the approach to the airway very easy for the anaesthesiologist performing intubation. Though fibreoptic intubation and videolaryngoscope-aided intubation would have possibly made the airway approach even easier, in our resource-limited conditions, McCoy levering laryngoscope, intubating laryngeal mask airway and intubating bougie were the only airway equipment available to deal with this situation.