Fluoroscopic observation of the occipitoatlantoaxial complex during intubation attempt in a rheumatoid patient with severe atlantoaxial subluxation.

摘要

Atlantoaxial subluxation (AAS) is found in 11-46% of patients with rheumatoid arthritis. Rheumatoid patients with AAS may be at risk of life-threatening neurologic injury caused by exacerbation of the subluxation in the head and neck position during airway maneuver; therefore, appropriate management of the cervical spine is essential. Tokunaga et al. have recommended the protrusion position, which is equal to the posture used in anesthesiology as the sniffing position, during intubation attempt in these patients to reduce subluxation. In contrast, previous studies have shown that accomplishment of the protrusion position sometimes results in worsening AAS in rheumatoid patients with severe instability of the occipitoatlantoaxial (OAA) complex.