Airway management in patients with cervical spine trauma and neurological symptoms. Case reports
Patients with traumatic injuries of the cervical spine who undergo a surgical intervention are a great challenge to the anesthesiologist. The airway management inherently involves movements of the cervical spine that may aggravate pre-existing injury. Currently there is not a consensus for the technique of intubation of these patients.
We present three patients with traumatic injuries associated neurological symptoms and cervical spine. All intubations were assisted with fiber bronchoscope, without removing the cervical collar and patients remained awake. All patients were examined again after intubation with no evidence of worsening of their neurological symptoms. We can conclude that the fiberoptic assisted intubation has several advantages in the care of these patients.
2. Crosby ET. Tracheal intubation in the cervical spine-injured patient. Can J Anaesth. 1992;39:105-9.
3. Kwan I, Bunn ERoberts I. Spinal immobilisation for trauma patients. Cochrane Database Syst Rev. 2001;2:CD002803.
4. American College of Surgeons: Committee on Trauma. Advanced trauma life support program for Doctors. 9th ed. Chicago, IL: American College of Surgeons; 2012.
5. Lennarson PJ, Smith DW, Sawin PD, Todd MM, Sato Y, Traynelis VC. Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability. J Neurosurg. 2001;94:265-70.
6. Santoni BG, Hindman BJ, Puttlitz CM. Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation. Anesthesiology. 2009;110:24-31.
7. Nolan JP, Wilson ME. Orotracheal intubation in patients with potential cervical spine injuries. An indication for the gum elastic bougie. Anaesthesia. 1993;48:630-3.
8. Aziz M. Use of video-assisted intubation devices in the management of patients with trauma. Anesthesiol Clin. 2013;31:157-66.
9. Trimmel H, Kreutziger J, Fertsak G, Fitzka R, Dittrich M, Voelckel WG. Use of the Airtraq laryngoscope for emergency intubation in the prehospital setting: a randomized control trial. Cri Care Med. 2011;39:489-93.
10. Brimacombe J, Keller C, Kunzel KH, Gaber O, Boehler M, Puhringer F. Cervical spine motion during airway management; a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers. Anesth Analg. 2000;91:1274-8.
11. Sahin A, Salman MA, Erden IA, Aypar U. Upper cervical vertebrae movement during intubating laryngeal mask, fibreoptic and direct laryngoscopy: a video-fluoroscopic study. Eur J Anaesthesiol. 2004;21:819-23.
12. Goutcher CM, Lochhead V.Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005;95:344-8.
13. Donaldson WF, Heil BV, Donaldson VP, Silvagglo VJ. The effect of airway maneuvers on the unstable C1-C2 segment: a cadaver study. Spine. 1997;22:1215-8.
14. Koerner I, Brambrink AM. Fiberoptic techniques. Best Pract Res Clin Anaesthesiol. 2005;19:611-21.
15. Asai T, Shingu K. Tracheal intubation through the intubating laryngeal mask in patients with unstable necks. Acta Anaesthesiol Scand. 2001;45:818-22.
16. Panjwani S, Seymour P Pandit JJ. A manoeuvre for using the flexible fibreoptic bronchoscope through the Intubating Laryngeal Mask Airway. Anaesthesia. 2001;56:696-7.
17. Arslan ZI, Yildiz T, Baykara ZN, Solak M, Toker K. Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA CTrach devices. Anaesthesia. 2009;64:1332-6.
18. Rosenblatt WH, Wagner PJ, Ovassapian A, Zain ZN. Practice patterns in managing the difficult airway by anesthesiologists in the United States. Anesth Analg. 1998;87:153-7.
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