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

• Published in: Curēus (Palo Alto, CA) Vol. 16; no. 7; p. e64270
• Main Authors: Veligandla, Sravya, Pasca, Ioana F, Radhakrishnan, Trinith, Arif, Haad, Ignacio, Gian Christian T, Sinha, Ashish
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 10.07.2024
• Subjects: Anesthesia; Anesthesiology; Back surgery; Bronchitis; Bronchoscopy; Cardiac arrest; Case reports; Catheters; Emergency medical care; Intubation; Magnetic resonance imaging; Neurosurgery; Oxygen saturation; Patients; Suctioning; Ventilators; United States > US; Loma Linda California; chronic obstructive pulmonary disease (copd); prone position surgery; glycopyrrolate; mayfield pins; flexible bronchoscope; mucous plug; posterior cervical fusion; chronic bronchitis; odontoid process fracture; prone bronchoscopy
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.64270

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 (ETCO ) while the patient was in Mayfield head pins. With limited airway access, suctioning and prone flexible bronchoscopy were performed, successfully restoring ETCO . This experience underscores the need for heightened awareness and preparedness for mucus plug obstruction in chronic bronchitis patients undergoing prone cervical spine surgeries.