An optimized "sTOP" strategy-based awake fiberoptic intubation for a patient with severe scoliosis after halo-pelvic traction.

Difficult Airway Society launched the new guideline for awake tracheal intubation (ATI) in adults with the goal of standardizing and promoting ATI techniques to protect the airway in 2020 (Anaesthesia, 2020;75:509). Specifically, the guideline highlighted that the key components of ATI are sedation, topicalization, oxygenation, and performance, coined "sTOP." To the best of our knowledge, anticipated difficult airway is the best indication for ATI. Patients with severe scoliosis undergoing halo-pelvic traction (HPT) are often with head and neck fixation, thereby contributing to the anticipated difficult airways. HPT was first used to fix unstable cervical vertebra segments in 1959, and gradually applied in the treatment of scoliosis (scoliosis or kyphosis Angle greater than 90 degrees is usually considered as severe scoliosis), with favorable efficacy and safety profile, and thus widely used in clinical practice (Clin Orthop Relat Res, 1973;93:179). To date, the improved HPT device usually consists of a head ring composed of 6 ~ 8 cranial nails, a pelvic ring composed of 6 ~ 8 iliac bone nails and 4 telescopic connecting rods, which can achieve all-day continuous traction. Usually, the average traction time was about 8 weeks (Chin Med J (Engt), 2012;125:1297). Our case described a planned awake fiberoptic intubation (AFOI) for a patient with severe scoliosis undergoing HPT via an optimized "sTOP" strategy.