Awake Fiberoptic Intubation for Cesarean Section in a Parturient with Odontoid Fracture and Atlantoaxial Subluxation

We report on the anesthetic experience of a 38-week pregnant patient in labor with anupper cervical spinal cord injury after an unusual trauma. She was transferred from a districthospital to our medical center with acute quadriplegia and sensory loss. Plain cervical spinex-ray and computed tomographic scan showed a C2 odontoid (dens of axis) process type IIfracture and atlantoaxial (C1-C2) subluxation. Due to having regular uterine contractionsand labor pain, she was scheduled for an urgent cesarean section. The instability of her cervicalspine precluded the use of regional anesthesia; so awake nasal fiberoptic endotrachealintubation followed by general anesthesia was performed. The anesthetic course wasuneventful, and the outcome of the parturient and newborn was good. We discuss our anestheticconsiderations, intubation techniques and a review of the literature.