Airway management in the patient with potential cervical spine instability: Continuing Professional Development

Robitaille, Arnaud

doi:10.1007/s12630-011-9597-0

Cited by 17 publications

(5 citation statements)

References 31 publications

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“…114 A key issue associated with collars in prehospital care is the increased difficulty it may entail for airway management. 72,[115][116][117][118][119][120][121][122][123][124][125][126] Mouth opening can be compromised and aspiration can more easily result from vomiting, especially in the supine position. 72,127,128 Collars may also cause respiratory restriction, an effect that is more pronounced if spine boards are added.…”

mentioning

confidence: 99%

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Sundstrøm

Asbjørnsen

Habiba

et al. 2014

Journal of Neurotrauma

144

115

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The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.

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mentioning

confidence: 99%

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Sundstrøm

Asbjørnsen

Habiba

et al. 2014

Journal of Neurotrauma

144

115

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“…The most common site of injury is the cervical spine 2 (C-spine 2, C2), and C6 and C7 are vulnerable [ 44 ]. The probability of a C-spine injury increases in the elderly, because of degenerative changes in the spine [ 45 ]. However, head injury patients are approximately fourfold more likely to have additional C-spine injuries than those without head injury.…”

Section: Assessment Of Cervical Spine Injurymentioning

confidence: 99%

Airway management of patients with traumatic brain injury/C-spine injury

Jung

2015

Korean J Anesthesiol

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Traumatic brain injury (TBI) is usually combined with cervical spine (C-spine) injury. The possibility of C-spine injury is always considered when performing endotracheal intubation in these patients. Rapid sequence intubation is recommended with adequate sedative or analgesics and a muscle relaxant to prevent an increase in intracranial pressure during intubation in TBI patients. Normocapnia and mild hyperoxemia should be maintained to prevent secondary brain injury. The manual-in-line-stabilization (MILS) technique effectively lessens C-spine movement during intubation. However, the MILS technique can reduce mouth opening and lead to a poor laryngoscopic view. The newly introduced video laryngoscope can manage these problems. The AirWay Scope® (AWS) and AirTraq laryngoscope decreased the extension movement of C-spines at the occiput-C1 and C2-C4 levels, improving intubation conditions and shortening the time to complete tracheal intubation compared with a direct laryngoscope. The Glidescope® also decreased cervical movement in the C2-C5 levels during intubation and improved vocal cord visualization, but a longer duration was required to complete intubation compared with other devices. A lightwand also reduced cervical motion across all segments. A fiberoptic bronchoscope-guided nasal intubation is the best method to reduce cervical movement, but a skilled operator is required. In conclusion, a video laryngoscope assists airway management in TBI patients with C-spine injury.

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“…1 Several methods with which to maintain a neutral head position have been studied, such as the use of cervical collars, sandbag, tapes, and manual in-line stabilization. [2][3][4][5] These methods can limit cervical spine movement. However, they make tracheal intubation more challenging, even for experienced anesthesiologists, leading to increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

Kim

Yoon

et al. 2019

J Int Med Res

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ObjectiveThis study was performed to compare the use of a video laryngoscope-guided lightwand versus a single lightwand for tracheal intubation performed by non-experts in cervical spine-immobilized patients.MethodsIn total, 318 patients under general anesthesia were assigned either to the single lightwand group (Group L) or the video laryngoscope-guided lightwand group (Group VL) at a 1:1 ratio. First- or second-grade residents performed tracheal intubation with the assigned device after applying semi-hard fitted cervical collars to the patients. Outcomes, including the success rate and airway complications, were compared between the two groups.ResultsThere were no significant differences in demographics or airway-related characteristics between the two groups. The success rate of intubation on the first attempt was significantly higher in Group VL than in Group L (90% vs. 64%, respectively). Postoperative complications, including oral mucosal bleeding, hoarseness, and sore throat scores at 1 and 24 hours after surgery, were significantly lower in Group VL than in Group L.ConclusionsThe use of a video laryngoscope-guided lightwand for tracheal intubation can be useful for non-experts who encounter difficult airway situations.

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Airway management in the patient with potential cervical spine instability: Continuing Professional Development

Cited by 17 publications

References 31 publications

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Airway management of patients with traumatic brain injury/C-spine injury

Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

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