Patient in Mayfield Head Pins Requiring Prone Bronchoscopy for Mucus Plug Obstruction: A Case Report

TL;DR

A patient with chronic bronchitis developed mucus plug obstruction during prone cervical surgery, requiring bronchoscopy to restore ventilation.

Contribution

Highlights the risk of mucus plug obstruction in prone cervical spine surgery for chronic bronchitis patients.

Findings

Mucus plug obstruction occurred despite preoperative secretion removal in a prone patient.

Prone flexible bronchoscopy successfully restored end-tidal CO2 during surgery.

Chronic bronchitis patients require heightened awareness for airway management in prone positioning.

Abstract

Mucus plug obstruction is a common complication in prone patients associated with loss of ventilation and hemodynamic instability. This case presents a 62-year-old female with chronic bronchitis who underwent posterior cervical fusion for a type III dens fracture with extension into the pars articularis and pedicles. Glycopyrrolate was administered to assist with fiberoptic intubation. After successful intubation, bronchoscopy revealed copious endotracheal secretions requiring preoperative therapeutic removal. Despite extensive removal of thick endotracheal secretions preoperatively, obstructive mucus plugging developed intraoperatively with complete loss of end-tidal carbon dioxide (ETCO2) while the patient was in Mayfield head pins. With limited airway access, suctioning and prone flexible bronchoscopy were performed, successfully restoring ETCO2. This experience underscores the need for heightened awareness and preparedness for mucus plug obstruction in chronic bronchitis patients undergoing prone cervical spine surgeries.

Figures