{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T10:59:41Z","timestamp":1761649181469,"version":"3.40.5"},"reference-count":5,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","license":[{"start":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T00:00:00Z","timestamp":1686268800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6,9]]},"abstract":"<jats:sec>\n            <jats:title>Rationale:<\/jats:title>\n            <jats:p>Nasotracheal intubation is an advanced airway modality used in specific contexts, such as limited mouth opening, macroglossia, cervical spine instability. In addition, it can be performed with the patient awake, especially when predictors a difficult airway are unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient concerns:<\/jats:title>\n            <jats:p>A 41-year-old male with a lesion in the C1 cervical vertebra, associated with a fracture of the right maxilla, was intubated through the nasopharyngeal route while awake. The forms of induction were discussed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Diagnoses:<\/jats:title>\n            <jats:p>Based on the mechanism of trauma and on the report of pain, associated with imaging examination, fracture of the body of the right maxilla and a complex fracture of the anterior arch of the C1 cervical vertebra were diagnosed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Interventions:<\/jats:title>\n            <jats:p>In this case, we present a patient with trauma to the face and spine who was intubated through the nasopharyngeal route while awake and guided by video laryngoscopy and using a rigid cervical collar. The patient was operated on under total general anesthesia (propofol and remifentanil) and plates and screws were placed for maxillary osteosynthesis. The pain was alleviated with a peripheral block of the trigeminal nerve of the maxillary branch with 0.5% levobupivacaine.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcomes:<\/jats:title>\n            <jats:p>The patient woke up from surgery, was extubated uneventfully and without pain. Cervical spine injuries were followed up by the neurosurgery team for conservative treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Lessons:<\/jats:title>\n            <jats:p>Patients with neck injury and facial trauma may need a definitive airway either for emergencies or for elective procedures. Intubating the awake patient may be an option when the anatomy of the cavity is unknown, and inducing the anesthetic act without this knowledge may be a inappropriate option, due to the risk of intubation\/ventilation difficulties.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/md.0000000000034028","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T14:05:18Z","timestamp":1686319518000},"page":"e34028","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Nasotracheal intubation awake in a patient with multiple fractures of the maxilla and cervical spine: A case report"],"prefix":"10.1097","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-0168","authenticated-orcid":false,"given":"Luan Oliveira","family":"Ferreira","sequence":"first","affiliation":[{"name":"Programa de Resid\u00eancia M\u00e9dica em Anestesiologia, Hospital Universit\u00e1rio Jo\u00e3o de Barros Barreto, Bel\u00e9m, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria Winkler","family":"Vasconcelos","sequence":"additional","affiliation":[{"name":"Programa de Resid\u00eancia M\u00e9dica em Anestesiologia, Hospital Universit\u00e1rio Jo\u00e3o de Barros Barreto, Bel\u00e9m, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imaikon Gomes","family":"de Lima","sequence":"additional","affiliation":[{"name":"Departamento de Anestesiologia, Hospital Metropolitano de Urg\u00eancia e Emerg\u00eancia, Bel\u00e9m, Brasil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana Barbosa","family":"de Souza","sequence":"additional","affiliation":[{"name":"Departamento de Anestesiologia, Hospital Metropolitano de Urg\u00eancia e Emerg\u00eancia, Bel\u00e9m, Brasil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karina Dias","family":"Resende","sequence":"additional","affiliation":[{"name":"Programa de Resid\u00eancia M\u00e9dica em Anestesiologia, Hospital Universit\u00e1rio Jo\u00e3o de Barros Barreto, Bel\u00e9m, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20250504","doi-asserted-by":"crossref","first-page":"40","DOI":"10.4103\/njms.NJMS_71_17","article-title":"Effect of 4% nebulized lignocaine versus 2% nebulized lignocaine for awake fibroscopic nasotracheal intubation in maxillofacial surgeries.","volume":"11","author":"Kumar","year":"2020","journal-title":"Natl J Maxillofac Surg"},{"key":"R2-20250504","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/ALN.0000000000004002","article-title":"2022 American society of anesthesiologists practice guidelines for management of the difficult airway.","volume":"136","author":"Apfelbaum","year":"2022","journal-title":"Anesthesiology"},{"key":"R3-20250504","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s12871-020-01021-x","article-title":"Comparison of C-MAC D-blade video laryngoscope and McCoy laryngoscope efficacy for nasotracheal intubation in simulated cervical spinal injury: a prospective randomized comparative study.","volume":"20","author":"Seo","year":"2020","journal-title":"BMC Anesthesiol"},{"key":"R4-20250504","doi-asserted-by":"crossref","first-page":"732","DOI":"10.4103\/0019-5049.191676","article-title":"Does C-MAC video laryngoscope improve the nasotracheal intubating conditions compared to Macintosh direct laryngoscope in paediatric patients posted for tonsillectomy surgeries?","volume":"60","author":"Patil","year":"2016","journal-title":"Indian J Anaesth"},{"key":"R5-20250504","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1080\/22201173.2008.10872562","article-title":"Anaesthetic challenges in a patient with ludwig angina: a case report.","volume":"14","author":"Saini","year":"2008","journal-title":"South African J Anaesth Analg"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000034028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T02:02:41Z","timestamp":1746324161000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000034028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,9]]},"references-count":5,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000034028","relation":{},"ISSN":["0025-7974"],"issn-type":[{"type":"print","value":"0025-7974"}],"subject":[],"published":{"date-parts":[[2023,6,9]]}}}