Crisis resource management of the airway in a patient with Klippel-Feil syndrome, congenital deafness, and aortic dissection

Anesth Analg. 2009 Apr;108(4):1220-5. doi: 10.1213/ane.0b013e3181957d9b.


Klippel-Feil syndrome is a visually arresting deformity wherein severe restriction of cervical motion predicts a difficult airway. Even minor distraction of the neck risks cervical spine or neurologic injury, so regional techniques, awake fiberoptic intubation, or awake tracheostomy are recommended anesthetic approaches. We present a case of aortic dissection in a Klippel-Feil syndrome patient for whom congenital bilateral deafness, coupled with the urgency of the surgery, mitigated against the recommended first-choice techniques. Using anesthesia crisis resource management methods, a multi-member team rehearsed predefined roles and then managed the airway via inhaled induction of anesthesia, followed by flexible fiberoptic intubation.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Algorithms
  • Anesthesia, General* / psychology
  • Anxiety / etiology
  • Anxiety / prevention & control
  • Aortic Aneurysm / complications
  • Aortic Aneurysm / surgery*
  • Aortic Dissection / complications
  • Aortic Dissection / surgery*
  • Blood Pressure
  • Bronchoscopes
  • Bronchoscopy*
  • Cervical Vertebrae / abnormalities
  • Deafness / complications*
  • Deafness / congenital
  • Humans
  • Intubation, Intratracheal / instrumentation
  • Intubation, Intratracheal / methods*
  • Intubation, Intratracheal / psychology
  • Klippel-Feil Syndrome / complications*
  • Klippel-Feil Syndrome / pathology
  • Laryngoscopes
  • Laryngoscopy*
  • Male
  • Monitoring, Intraoperative
  • Optical Fibers
  • Patient Care Planning
  • Patient Care Team
  • Treatment Outcome
  • Vascular Surgical Procedures* / psychology