Lee, Yi-HuiYi-HuiLeeHsieh, Pei-FangPei-FangHsieh​HUI-HSUN HUANGKUANG-CHENG CHAN2018-09-102018-09-102008http://www.scopus.com/inward/record.url?eid=2-s2.0-54449091181&partnerID=MN8TOARShttp://scholars.lib.ntu.edu.tw/handle/123456789/336873Upper airway obstruction is one of the life-threatening events in cervical spine surgery. The risk is particularly great during the period immediately after operation. We present the case of a 56-year-old female with breast cancer and metastasis to the cervical spine. The surgical procedure involved C2-C3 laminectomy, posterior fixation (C0-C5), and C2 neurectomy. Tracheal extubation was carried out in the intensive care unit, and upper airway obstruction immediately followed. Emergency cricothyrotomy was performed under well-managed ventilation with a laryngeal mask after several failed intubation attempts. Over-flexion of the cervical spine fixation and severe prevertebral soft tissue swelling were the most probable causes of upper airway obstruction. With a well-adjusted angle for fixation of the cervical spine under fluoroscopic guidance before the procedure, such a surgical mishap could be avoided. Reintubation with a fiberscope might be considered first, and sustaining intubation for 2-3 days postoperatively could be safer in such high risk patients. ? 2008 Taiwan Society of Anesthesiologists.Airway obstruction; Cervical vertebrae; Spinal fusion[SDGs]SDG3adult; article; artificial ventilation; breast cancer; case report; cervical spine; clinical feature; disease severity; emergency surgery; extubation; female; general anesthesia; human; laminectomy; laryngeal mask; mastectomy; nasotracheal intubation; neurectomy; nuclear magnetic resonance imaging; oxygen saturation; soft tissue disease; spine fusion; spine metastasis; surgical approach; tracheotomy; upper respiratory tract obstructionjournal article10.1016/S1875-4597(08)60008-9