BACKGROUND: Arnold Chiari malformations (ACMs) are a group of rare and congenital neurological conditions that consist of an altered anatomy of the skull base, leading to protrusion of neural structures. These patients, due to compression risk of herniated neural structures, should be intubated without cervical mobilization, thus, among the available techniques, videolaryngoscopy is well indicated1. CASE REPORT: This case deals with the airway management in a male patient, 26 years old, 72kg, ASA I, with Chiari malformation type I in a tertiary hospital in the Amazon region, complaining of cervicalgia, hypoesthesia, hemiparesis and gradual loss of pain and thermal sensation in right half-body, 10 months of evolution. After monitoring, pre-oxygenation and anesthetic induction, it was conducted orotracheal intubation with a videolaringo device (trueview®). DISCUSSION: Patients with ACM type I should always be considered as having a difficult airway, Since it is necessary to immobilize the cervical, making it impossible to apply the sniff position. It is a mandatory condition to establish an approach plan, following the devices available in each service. In the present case, trueview® was used because it was readily available and because videolaryngoscopy improves Cormack-Lehane and offers a lower risk of hemodynamic repercussions/intracranial hypertension2. Other airway management devices can be used successfully, as long as they allow stability of the cervical spine. LEARNING POINTS (1) Patients with ACM type I should always be considered as having a difficult airway, thus, it is a mandatory condition to establish an approach plan, following the devices available in each service; (2) Due to the risk of neural structures compression, intubation must occur without cervical mobilization; (3) Among the available techniques, videolaryngoscopy is well indicated because it offers good view of the airway and lower risk of hemodynamic repercussions/intracranial hypertension; (4) Knowing the disease, especially regarding the limitations involving the cervical spine, is the success for an adequate management of the airway to avoid iatrogenesis. REFERENCES: (1) Farag E. Airway management for cervical spine surgery. Best Practice & Research Clinical Anaesthesiology, 2016; 30:13-25. (2) Rodriguez-Zepeda JM et al. Manejo anestésico en una mujer con malformación de Arnold-Chiari tipo II residual. Revista Mexicana de Anestesiologia, 2015; 38(3):195-198.
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