Secondary cervical spine injury during airway management: beyond a ‘one-size-fits-all’ approach

Duggan, Laura V.; Griesdale, Donald

doi:10.1111/anae.13163

Cited by 9 publications

(8 citation statements)

References 39 publications

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“…Prevention of secondary insult to the cervical spinal cord is paramount during airway management when cervical spine instability (CSI) is present. [ 1 ] A plethora of research on different intubation techniques in actual or simulated CSI has been published. [ 2 3 4 5 ] However, current studies largely focus on surrogate outcomes, such as intubation success rate or degree of cervical spine movement versus patient-centric outcomes such as intubation-associated neurological deficits.…”

Section: Introductionmentioning

confidence: 99%

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

et al. 2018

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Background and Aims:There is a paucity of clinical practice guidelines for the ideal approach to airway management in patients with cervical spine instability (CSI). The aim of this survey was to evaluate preferences, perceptions and practices regarding airway management in patients with CSI among neuroanaesthesiologists practicing in India.Methods:A 25-item questionnaire was circulated for cross-sectional survey to 378 members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) by E-mail. We sent four reminders and again submitted our survey to non-responders during the 2017 annual ISNACC meeting. Apart from demographic information, the survey captured preferred methods of intubation and airway management for patients with CSI and their justification. Regression analysis was used to identify factors associated with the use of indirect technique for intubation.Results:Only 122 out of the 378 anaesthesiologists responded to our survey. Most respondents were senior consultants, working in training hospitals, and performed ≥25 intubations per year for CSI patients. The majority of neuroanaesthesiologists (78.7%; n = 96) preferred indirect techniques for elective intubation. However, 45 anaesthesiologists (36.9%) preferred indirect techniques for emergency intubation. In an adjusted analysis, preference for patients to be conscious during intubation was significantly associated with the use of indirect techniques (odds ratio = 3.79; confidence interval = 1.52–9.49, P < 0.01).Conclusions:Among ISNACC members, indirect techniques are preferred for elective intubation of patients with CSI, while direct laryngoscopy is preferred for emergency intubation.

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Section: Introductionmentioning

confidence: 99%

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

et al. 2018

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“…Secondary spinal injury during airway management is not only a result of the mechanical disruption of the unstable segments, but hypoxia is also likely to cause harm [1,20]. Although both LMA CTrach and LMA Fastrach administrations may prolong intubation, they have established roles in difficult airway management since they do not interrupt ventilation [8,21].…”

Section: Discussionmentioning

confidence: 99%

“…Intubation with various airway devices causes cervical spine (C-spine) extension to some degree. The process gains importance especially in emergency situations with cervical injury and in C-spine surgeries [1,2]. The main concerns of anesthesiologists for airway management both in cervical injury and C-spine surgeries include avoiding prolonged intubation time and preventing neurologic damage due to excess cervical movements [2,3].…”

Section: Introductionmentioning

confidence: 99%

Radiographic comparison of cervical spine motion using LMA Fastrach, LMA CTrach and Macintosh laryngoscope

Inan¹,

Bedirli²,

Şatirlar³

2019

Turk J Med Sci

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Background/aim: The optimal technique for airway management in patients with cervical pathology remains unclear. Intubating laryngeal mask airway devices such as LMA CTrach and LMA Fastrach have not been compared for cervical spine (C-spine) movements in the context of cervical pathology. The present study aimed to determine upper C-spine movements by radiography during intubation with different devices as well as comparing the duration and success of intubation in cervical surgery. Materials and methods: Sixty patients scheduled for elective cervical surgery were registered in this prospective, randomized study. Patients with cervical trauma/injury, previous neck surgery, and body mass index (BMI) of >35 kg/m 2 were excluded. Participants were randomized to one of the 3 groups: LMA CTrach, LMA Fastrach, or the Macintosh laryngoscope. C-spine motion was evaluated by measuring angles created by bordering vertebrae at cervical 1/2 and 2/3 (C1/2, C2/3) segments on 2 lateral cervical radiographs for each patient. Intubation time, ease of intubation, number of attempts, and success rate were also documented. Results: Demographic data were similar in all the groups. The cervical movement with LMA CTrach and LMA Fastrach compared to the Macintosh laryngoscope were similar at C1/2. However, LMA CTrach significantly reduced extension compared to LMA Fastrach and Macintosh laryngoscopes at C2/3. Duration of intubation was significantly shorter with the Macintosh laryngoscope. The rate of successful intubation was 80% with LMA Fastrach and 100% with both LMA CTrach and the Macintosh laryngoscopes. Conclusion: The LMA CTrach laryngoscopy involves less upper C-spine movement than the LMA Fastrach and does not increase the duration of the intubation period.

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“…Conventional direct laryngoscopy has higher failure rate compared to other newer alternative devices (video laryngoscopes) for intubation [25]. The Air tray was associated with a significant reduction of the risk of intubation failure at the first attempt [28]. However, the available literature was too weak to make a statistically significant difference.…”

Section: Indirect Laryngoscopy Using Videoscopementioning

confidence: 99%

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2018

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Secondary cervical spine injury during airway management: beyond a ‘one-size-fits-all’ approach

Cited by 9 publications

References 39 publications

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

Radiographic comparison of cervical spine motion using LMA Fastrach, LMA CTrach and Macintosh laryngoscope

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