357: Using Of Spinal anesthesia for bone marrow biopsy in a child with severe airway obstruction

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute cancer related pain, Pain in Special Populations , Treatment/management , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Background: Children with suspected lymphoma and airway-compromising cervical lymphadenopathy present major anesthetic challenges. Sedation or general anesthesia risks airway collapse. This case highlights successful use of spinal anesthesia in a high-risk pediatric patient with severe airway compromise.
Case report: An 11-year-old boy presented with massive bilateral neck masses, and inability to lie supine. Lymphoma was strongly suspected, and urgent diagnostic procedures were required.
Clinical findings: Airway: Audible stridor, hoarseness, positional intolerance.
Neck: Large bilateral lymphadenopathy.
ENT: Kissing tonsils causing severe airway narrowing.

Methods: Decision-making: Local anesthesia was refused; sedation/general anesthesia posed extreme airway risk. A multidisciplinary team (anesthesiology, pediatric oncology, PharmD) reviewed the plan. Compatibility between heavy bupivacaine 0.5% and intrathecal chemotherapeutics was confirmed. Spinal anesthesia was deemed safe and appropriate.
Anesthetic Technique:
Patient seated to maintain airway patency.
22G pencil-point spinal needle inserted at lumbar region.
2 mL of 0.5% heavy bupivacaine administered.
CSF obtained for diagnostics; triple intrathecal therapy administered safely.
No airway events, desaturation, hypotension, or neurologic complications.
Spontaneous breathing maintained.
Patient and family satisfied with safety and comfort.

Results: Discussion: Airway compromise in pediatric lymphoma creates high-risk anesthetic scenarios. Sedation or general anesthesia may precipitate airway collapse; awake fiberoptic intubation is often poorly tolerated in children. Spinal anesthesia, though uncommon for these procedures, offered key advantages:
- Preserved spontaneous ventilation
- Avoided airway manipulation
- Enabled diagnostic and therapeutic interventions
- Multidisciplinary collaboration ensured drug compatibility and procedural safety.

Conclusions: Discussion: Airway compromise in pediatric lymphoma creates high-risk anesthetic scenarios. Sedation or general anesthesia may precipitate airway collapse; awake fiberoptic intubation is often poorly tolerated in children. Spinal anesthesia, though uncommon for these procedures, offered key advantages:
- Preserved spontaneous ventilation
- Avoided airway manipulation
- Enabled diagnostic and therapeutic interventions
- Multidisciplinary collaboration ensured drug compatibility and procedural safety.

References: References: Anesthetic management of children with anterior mediastinal mass — PubMed
Clinical and diagnostic imaging findings predict anesthetic complications — PMC
Simplified approach for anesthetic management in mediastinal mass — PMC
Learning Points: Severe airway compromise makes sedation/general anesthesia hazardous.
Spinal anesthesia can be a safe alternative when airway manipulation must be avoided.
Multidisciplinary consultation is essential for drug compatibility and safety.

Presenting Author: Mohammad Riziq
Submitting Author: Amin Albaik

Senior Author: Amin Albaik

IASP 2026 Global Year theme of Neuropathic Pain: No

• Samah Abughanam - King Huissne Cancer Centre
• Mohammad Riziq - King Hussein Cancer Center / Jordan