Abstract
Inability to secure the airway of a patient after induction of anaesthesia may lead
to serious consequences including permanent brain damage and even death. Hypoxia is
quite common in difficult intubations especially when it is difficult to ventilate
the patient. However, carbon dioxide retention severe enough to cause carbon dioxide
narcosis and delayed recovery is a rare occurrence. Here, we report a case of a craniovertebral
junction anomaly where inadequate ventilation after induction of anaesthesia resulted
in carbon dioxide narcosis and delayed awakening. A 54-year-old, American Society
of Anesthesiologists II female patient weighing 70 kg with a diagnosis of craniovertebral
junction was scheduled for implant removal for dislodged occipital screw. Fibreoptic
intubation was attempted after induction of anaesthesia and muscle paralysis. Even
after multiple attempts, intubation could not be done and ventilation by face mask
became difficult. Though oxygen saturation could be maintained with the insertion
of a laryngeal mask airway (LMA), ventilation was not adequate. The patient remained
unresponsive long after discontinuation of anaesthetic agent and reversal of muscle
paralysis. Subsequent blood gas analysis showed severe carbon dioxide retention and
respiratory acidosis. Patient was given assist control mechanical ventilation through
LMA. LMA was removed after improvement in sensorium and the blood gas picture.
Keywords
Carbon dioxide - delayed recovery - difficult airway - narcosis - respiratory acidosis
