2024, Vol. 7, Issue 1, Part B

During induction of anaesthesia, a huge mass on the back of neck which does not allow the patient to lie supine is a risk factor for difficult airway. Proper positioning is pertinent for induction of anaesthesia, securing the airway and surgical accessibility. A mass on upper back which limits positioning of the patient supine for induction of anaesthesia is a challenge for anesthesiologist for the management of airway. Complications due to airway manipulation are one of the commonest causes for anaesthesia related morbidities and mortalities.

We report the anaesthetic management of a 70 year old male patient, having mouth opening of three finger with no teeth in both jaw scheduled for resection of a giant mass (Huge lipoma), over the upper back that Restricted flexion and extension movement of the neck.

Case Report: A 70-year-old male patient came to our medical college hospital about 6 months back, with a mobile, smooth-surfaced painless giant mass over back of the neck of 10 years duration. Local examination revealed an 12 x 10 cms sized ovoid, soft, smooth surfaced, mobile, non-tender, non-pulsatile, mass with no bruit. A fine needle aspiration cytology showed fibrofatty tissue histopathologically. Elective surgery was planned.

After confirming NBM status and taking consent of the patient. Patient taken inside OT. Monitors attached. Vitals noted. Iv fluid started. After that RAMP position given to the patient. Patient induced under general anaesthesia. Intra operatively maintained on oxygen + N₂O + isoflurane + intermittent vecuronium. Excision of lipoma done. Patient extubate well and shifted to recovery for observation.

Conclusion: Proper positioning of the patient is the most important step for induction of anaesthesia as well as securing the airway. This is best done in supine position. In a patient with a huge mass over the back which interferes with a suitable supine position, RAMP position plays most important role during intubation.