Abstract
Patients with severe ankylosing spondylitis (AS) have difficulties in tracheal intubation. An 87-year-old man with severe AS was scheduled for Zenker diverticulum (ZD) excision. It was decided to proceed with combined bilateral cervical plexus blockade using a nerve stimulator. The surgery lasted about 3 h, with stable hemodynamics, ECG, and oxygen saturation. The use of a nerve stimulator-guided cervical block minimizes the risk of severe respiratory and/or airway compromise secondary to phrenic nerve or recurrent laryngeal nerve palsy, because it can elicit diaphragmatic muscle response, which helps to avoid the administration of local anesthetic directly to the area of the phrenic nerve, and guides correct needle placement. In conclusion, the nerve stimulatorguided bilateral cervical block in our ZD patient with AS was shown to be a safe and successful alternative anesthetic option.
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References
Lu PP, Brimacombe J, Ho AC, Shyr MH, Liu HP. The intubating laryngeal mask airway in severe ankylosing spondylitis. Can J Anaesth. 2001;48:1015–1019.
Last RJ. The pharynx, anatomy, regional and applied. 5th ed. Last RJ, editor. London: Churchill Livingstone; 1973. p. 643–649.
Achkar E. Esophageal diverticula. In: Castell DO, Richter JE, editors. The esophagus. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 301–306.
Naja Z, Ziade MF, Lönnqvist PA. Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain. Can J Anaesth. 2005;52:62–68.
Naja MZ, Ziade MF, Lönnqvist PA. Nerve-stimulator guided paravertebral blockade vs general anesthesia for breast surgery: a prospective randomized trial. Eur J Anaesthesiol. 2003;20:897–903.
Thiagarajah S, Lear E, Keh M. Anesthetic implications of Zenker’s diverticulum. Anesth Analg. 1990;70:109–111.
Aouad MT, Berzina CE, Baraka AS. Aspiration pneumonia after anesthesia in a patient with a Zenker diverticulum. Anaesthesiology. 2000;92:1837–1839.
Khan ZH. Regurgitation following induction of anesthesia in a patient with Zenker’s diverticulum—a case report. Middle East J Anaesthesiol. 1993;12:143–147.
Suzuki A, Toyama Y, Iwasaki H, Henderson J. Airtraq for awake tracheal intubation. Anaesthesia. 2007;62:746–747.
Suzuki A, Kunisawa T, Takahata O, Iwasaki H, Nozaki K, Henderson JJ. Pentax-AWS (Airway Scope) for awake tracheal intubation. J Clin Anesth. 2007;19:642–643.
Stoneham M, Knighton J. Regional anesthesia for carotid endarterectomy. Br J Anaesth. 1999;82:910–919.
Mehta Y, Juneja R. Regional analgesia for carotid artery endarterectomy by Winnie’s single-injection technique using a nerve detector. J Cardiothorac Vasc Anesth. 1992;6:772–773.
Saxe AW, Brown E, Hamburger SW. Thyroid and parathyroid surgery performed with patient under regional anesthesia. Surgery. 1998;103:415–420.
Merle JC, Mazoit JX, Desgranges P, Abhay K, Rezaiguia S, Dhonneur G, Duvaldestin P. A comparison of two techniques for cervical plexus blockade: evaluation of effi cacy and systemic toxicity. Anesth Analg. 1999;89:1366–1370.
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Naja, Z.M., Al-Tannir, M.A., Zeidan, A. et al. Bilateral guided cervical block for Zenker diverticulum excision in a patient with ankylosing spondylitis. J Anesth 23, 143–146 (2009). https://doi.org/10.1007/s00540-008-0699-y
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DOI: https://doi.org/10.1007/s00540-008-0699-y