ANESTHETIC CHALLENGE IN A PATIENT WITH COMPRESSIVE CERVICAL CHORDOMA: A CASE REPORT

Compressive cervical chordoma is a rare, high-risk anesthetic situation because tumor-related distortion of the upper airway, proximity to neurovascular structures, and postoperative airway edema may make both intubation and extubation difficult. We report the case of a 73-year-old patient with a large left anterior cervical mass causing progressive dysphagia, dysphonia, hoarseness, and deviation of the aerodigestive tract. Cervical imaging showed a lesion invading the C6 vertebral body,associated with grade II vertebral collapse and extension into the left lateral cervical soft tissues.After multidisciplinary discussion with the neurosurgical team, an anticipated difficult-airway strategy was adopted. Topical airway preparation was performed with nasal naphazoline,nebulized 5% lidocaine, and oropharyngeal lidocaine gel. Airway nerve blocks were avoided because of markedly distorted anatomical landmarks. Awake nasotracheal intubation was achieved under flexible fiberoptic guidance after conscious sedation with midazolam 2 mg and titrated ketamine to a total dose of 100 mg, while spontaneous ventilation was preserved. Once tracheal intubation had been confirmed visually and by capnography, general anesthesia was completed with fentanyl 200 micrograms, propofol 100 mg, and rocuronium 50 mg. Anesthesia was maintained with age-adjusted sevoflurane at approximately 1 minimum alveolar concentration. Continuous invasive blood pressure monitoring was used, with a target mean arterial pressure of at least 80 mmHg. The intraoperative course was uneventful.