{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T18:16:53Z","timestamp":1793729813442,"version":"4.6.1"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:p>The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA.<\/jats:p>","DOI":"10.4103\/1658-354x.136637","type":"journal-article","created":{"date-parts":[[2014,7,10]],"date-time":"2014-07-10T08:33:25Z","timestamp":1404981205000},"page":"412-414","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel\u2013Feil syndrome"],"prefix":"10.4103","volume":"8","author":[{"given":"Ravi","family":"Bhat","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, SDM Medical College, Dharwad, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh S.","family":"Mane","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjunath C.","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. N.","family":"Suresh","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250926","first-page":"234","article-title":"Klippel-Feil syndrome and associated congenital abnormalities: Evaluation of 23 cases","volume":"40","author":"Mahiro\u011fullari","year":"2006","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"1-7","key":"R2-20250926","article-title":"A Child with a Difficult Airway: What Do I Do Next?","volume":"317","author":"Wald","year":"2011","journal-title":"American Society of Anesthesiologists annual meeting"},{"key":"R3-20250926","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/S0889-8537(02)00018-4","article-title":"Paediatric upper airway and congenital anomalies","volume":"20","author":"Infosino","year":"2002","journal-title":"Anesthesiol Clin North America"},{"key":"R4-20250926","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/S0140-6736(09)60695-4","article-title":"Cleft lip and palate","volume":"374","author":"Mossey","year":"2009","journal-title":"Lancet"},{"key":"R5-20250926","doi-asserted-by":"crossref","first-page":"272","DOI":"10.4097\/kjae.2012.62.3.272","article-title":"Fiberoptic intubation through a laryngeal mask airway as a management of difficult airwary due to the fusion of the entire cervical spine-A report of two cases","volume":"62","author":"Lee","year":"2012","journal-title":"Korean J Anesthesiol"},{"key":"R6-20250926","doi-asserted-by":"crossref","first-page":"523","DOI":"10.3171\/jns.1984.61.3.0523","article-title":"Identification and management of high-risk patients with Klippel-Feil syndrome","volume":"61","author":"Nagib","year":"1984","journal-title":"J Neurosurg"},{"key":"R7-20250926","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1213\/00000539-199111000-00028","article-title":"Retrograde-assisted fiberoptic tracheal intubation in Children with difficult airways","volume":"73","author":"Audenaert","year":"1991","journal-title":"Anesth Analg"},{"key":"R8-20250926","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1213\/01.ANE.0000180256.90643.D1","article-title":"Through-the-LMA fiberoptic intubation of the trachea in a patient with an unexpected difficult airway","volume":"101","author":"Ianchulev","year":"2005","journal-title":"Anesth Analg"},{"key":"R9-20250926","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1597\/08-009.1","article-title":"Flexible laryngeal mask airway for cleft palate surgery in children: A randomized clinical trial on efficacy and safety","volume":"46","author":"Kundra","year":"2009","journal-title":"Cleft Palate Craniofac J"},{"key":"R10-20250926","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/bja\/aeh248","article-title":"Intubating laryngeal mask airway allows tracheal intubation when the cervical spine is immobilized by a rigid collar","volume":"93","author":"Komatsu","year":"2004","journal-title":"Br J Anaesth"},{"key":"R11-20250926","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/BF03012981","article-title":"Intubation via LMA in pediatric patients with difficult airways","volume":"46","author":"Selim","year":"1999","journal-title":"Can J Anaesth"},{"key":"R12-20250926","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1111\/j.1365-2044.1994.tb04349.x","article-title":"A new technique for fibreoptic intubation in children","volume":"49","author":"Hasan","year":"1994","journal-title":"Anesthesia"},{"key":"R13-20250926","doi-asserted-by":"crossref","first-page":"168","DOI":"10.4097\/kjae.2013.64.2.168","article-title":"Usefulness of a Cook(R) airway exchange catheter in laryngeal mask airway-guided fiberoptic intubation in a neonate with Pierre Robin syndrome \u2014 A case report","volume":"64","author":"Choi","year":"2013","journal-title":"Korean J Anesthesiol"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01437113-201408030-00025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:46:13Z","timestamp":1787067973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01437113-201408030-00025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,7]]},"references-count":13,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2014]]}},"URL":"https:\/\/doi.org\/10.4103\/1658-354x.136637","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,7]]}}}