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Rheumatoid arthritis (RA) is a progressive symmetrical, deforming inflammatory polyarthropathy with numerous extra-articular features. The skeletal effects of RA are characterized by an inflammatory synovitis with progressive destruction of cartilage. This chapter presents a case study of a 62-year-old female with seropositive rheumatoid arthritis presented for anterior cervical discectomy and fusion for long-term progressive pain and upper extremity myelopathy. Preoperative imaging consisted of plain radiographs and magnetic resonance imaging of the cervical spine. This case illustrates several important issues that must be considered when identifying the airway management options for patients with cervical spine pathology. When considering the airway options for a patient with disease at the occipito-atlanto-axial (OAA) complex an appreciation of the importance of this area in overall airway management is necessary. Careful preoperative evaluation and planning are essential; adequate time and personnel should be allocated to securing the airway in a controlled and safe manner.
An excess of growth hormone (GH) from a pituitary adenoma can result in gigantism and acromegaly; neurosurgical intervention is often required. This chapter presents a case study of a 36-year-old female weighed 115 kg and was 218.5 cm tall. She was scheduled for a transsphenoidal resection of the pituitary adenoma that had caused her gigantism. From the viewpoint of airway management in the acromegalic patient, several concerns exist: the tongue may be enlarged; redundant folds of tissue may be present in the oropharynx; the epiglottis is often enlarged; and laryngeal stenosis occurs more frequently compared with the general population. In the case of gigantism, several additional potential problems should also be considered: possible need for an extra long operating table; possible need for an extra large laryngoscope; endotracheal tubes may need to be placed deeper than usual; and an extra large face mask may be needed as in our case.