Awake Fiberoptic Intubation and Self-positioning in Patients at Risk of Secondary Cervical Injury

Abstract

Our study demonstrates that awake fiberoptic intubation and patient self-positioning was feasible in this sample of patients at risk of secondary cervical injury. This technique may extend the opportunity of continuous neurological monitoring in patients with a risk of position-related cervical injury, especially where electrophysiological monitoring is not possible or is unavailable.

Role of multimodal intraoperative neurophysiological monitoring during positioning of patient prior to cervical spine surgery

“…During the anesthetic procedure, fiberoptic intubation may be requested in selected cases of cervical spinal cord surgeries, especially in cases where radiculopathy or significant instability of the cervical spine is present (Fessler and Sekhar, 2006). Moreover, Malcharek et al (2012) have proposed the performance of awake fiberoptic intubation and self-positioning to achieve continuous preoperative neurological monitoring (Malcharek et al, 2012). However, this technique may not be suitable for all kinds of patients, in this respect, neurophysiological monitoring could acquire a relevant role during this pre-surgical step.…”

Setting Priorities: The Timing and Indications for Rheumatoid Surgical Procedures

“…Additionally, nearly 80 % of RA patients may have laryngeal involvement and vocal cord dysfunction with swelling and periarytenoid infl ammation [ 21 ]. In the case of cervical spine instability, fi beroptic intubation with a C-collar is recommended [ 22 ].…”

An update on the prone position: Continuing Professional Development

“…L'approche à privilégier chez de tels patients pourrait consister à sécuriser les voies aériennes du patient alors qu'il est éveillé et en décubitus dorsal, puis de le positionner sur le ventre et de répéter l'examen neurologique avant l'induction de l'anesthésie. 14,15 Stratégie de ventilation Si des patients sains sont correctement positionnés sur le ventre, les changements au niveau de la mécanique pulmonaire et des échanges gazeux devraient être minimes. Toutefois, une mauvaise compliance de la cage thoracique et des pressions élevées au niveau des voies aériennes sont fréquemment observées chez les patients mal positionnés -ce qui souligne l'importance de la spirométrie peropératoire.…”

“…The preferred approach in these patients may be to secure the airway awake with the patient in the supine position, followed by prone positioning and repeat neurological testing before induction of anesthesia (with the patient prone). 14,15 Ventilation strategy There should be minimal changes in lung mechanics and gas exchange if healthy patients are correctly positioned prone. Nevertheless, poor chest wall compliance and high airway pressures are commonly observed in patients who are poorly positioned, a fact that highlights the consideration for intraoperative spirometry.…”