Non-asleep fibreoptic intubation in a 5 year old child with C1/C2 subluxation - A case report

Introduction: Spinal cord damage following cervical spine injury is a feared complication that can leave the patient disabled for life. Although awake fibreoptic endotracheal intubation is the gold standard in adult patients with unstable cervical spine injury to both minimize the manipulation of the neck and continued neuromonitoring, it is not a popular choice in the pediatric population due to their inability to tolerate the procedure and comprehend its need. Here we describe a non-asleep technique for endotracheal intubation in a 5 year old child with cervical spine injury. Case Summary: A previously healthy 5 year old child developed C1/C2 subluxation after falling from height. Her neck was stabilised with Somi brace and subsequently posted for C1/C2 wire fixation under general anesthesia. Her airway was intubated successfully without inducing anesthesia using a combination of flexible fibreoptic bronchoscope and sedation - midazolam + dexmedetomidine, while her Somi brace was left in place. This technique was opted to minimize neck manipulation and to allow for neurological examination immediately after intubation. Conclusion: Non-asleep fibreoptic endotracheal intubation is a feasible alternative and largely underutilized technique in the pediatric population which provides the advantages of an awake intubation and avoids the disadvantages of an asleep technique in patients with unstable cervical spine injuries.