Vital capacity rapid inhalation induction (VCRII) technique with sevoflurane for a rheumatoid patient with difficult airway

: Successful airway management in an adult female patient with limited cervical extension and a subluxation of bilateral jaw joints caused by rheumatoid arthritis was reported. We planned to reduce the intensity of pain in her right hand through neurolysis of the ulnar nerve in her right elbow joint. Right axillary nerve blockade with 1% lidocaine 10 ml and 0.25% bupivacaine 10 ml, was employed unsuccessfully to achieve adequate anesthetic effect. Anesthesia was administered using a vital capacity rapid inhalation induction (VCRII) technique with 5% sevoflurane in the oxygen. When the patient lost consciousness, a size 3 laryngeal mask airway (LMA) was inserted under spontaneous breathing on the first trial. There was very little hemodynamic change during the insertion of the LMA. Anesthesia was maintained with sevoflurane 1.5-2.0% in oxygen under spontaneous breathing. Emergence from anesthesia was rapid and no signs of upper airway obstruction were observed after the removal of the LMA. The use of the LMA with VCRII technique and anesthetic maintenance using sevoflurane, are likely to be an optional technique of airway management in patients with problematic airway.