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</td></tr></table>WikiSysophttps://pedsanesthesia.net/wiki/index.php?title=TYK134&diff=368&oldid=prevmetawikimedia>DrBobGreenberg at 00:01, 4 October 20152015-10-04T00:01:41Z<p></p>
<p><b>New page</b></p><div>__NOTOC__<br />
A 4 year-old boy with Down syndrome and obstructive sleep apnea presents<br />
for tonsillectomy and adenoidectomy. The child has not had cervical neck films.<br />
You perform a history and physical examination which reveals normal upper<br />
extremity strength and there is no clinical history of cervical myelopathy. How<br />
should you proceed?<br />
<br />
<br />
a) Obtain STAT cervical flexion/extension radiographs prior to proceeding<br />
<br />
b) Proceed with the case utilizing apneic fiberoptic intubation; direct<br />
laryngoscopy is contraindicated for this patient<br />
<br />
c) Cancel the case until c-spine has been cleared<br />
<br />
d) Proceed with general anesthesia and direct laryngoscopy, minimizing neck<br />
extension during airway management.<br />
<br />
e) None of the above<br />
<br />
<br />
<br />
<div class="mw-customtoggle-TYK_Answer" style="text-align: right; color:#0000ff">Click for Answer</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-TYK_Answer"><br />
==Answer==<br />
Answer d.<br />
<br />
While cervical instability may be present in Down syndrome, only 1 to<br />
2% of patients are symptomatic. Flexion/extension films are dependent on<br />
patient cooperation and are not necessarily predictive of risk for injury,<br />
particularly in young children such as this one. Thus, routine screening is not<br />
recommended for young children. While fiberoptic intubation is a reasonable<br />
choice, direct laryngoscopy is NOT contraindicated in this population.<br />
==Notes==<br />
<references /><br />
<br />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.<br />
==Keywords==<br />
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