The adult cervical spine: implications for airway management

Abstract

Anaesthetists are responsible for the management of the airway in patients with unstable cervical spines. Unfortunately, the anaesthetic literature does not contain a recent, critical analysis of the current medical literature to aid anaesthetists attending such patients. This review is intended to serve such a purpose. Using the Index Medicus as a guide, 30 years of medical literature were reviewed, with emphasis on the last ten years. Key words employed for this review are cited in the manuscript. Relevant papers were selected from anaesthetic, orthopaedic, rheumatologic, emergency medicine and trauma journals and reviewed. Relevant findings included the high prevalence of cervical spinal instability in such disorders such as Trisomy 21 and rheumatoid arthritis and the relatively low incidence after trauma. There are deficiencies in the minimalist approaches to assessing the cervical spine, such as a simple cross table lateral radiograph after trauma, as they are neither sensitive nor specific. Finally, recognizing the potential for instability and intubating with care, while avoiding spinal movement, appears to be more important than any particular mode of intubation in preserving neurological function.

Managing the airway in cervical spine injury

“…An attempt to select the method of airway management according to the 'degree of risk' has been made [64] but this assumes expertise with fibreoptic intubation. Possibly the most important consideration for the British clinician is to be aware of the traumatic injuries associated most commonly with cervical spine injury and subsequently t o proceed with techniques with which he/she practised [65]. Continuing education t o extend the range of airway skills is desirable and the benefits will not be confined to trauma care.…”

The effect of a cervical collar on the tidal volume of anaesthetised adult patients

“…Some authorities estimate that 1624% of trauma victims have a cervical spine injury [5] and an estimated 10% of these are missed on initial assessment in the emergency department [6]. These patients have a much higher incidence of secondary injury to the spine.…”

Acute spinal cord injury: monitoring and anaesthetic implications

“…This difficult issue was recently reviewed in depth by Crosby and Lui . 43 The optimal method depends on the patient's condition, the level of cooperation, and the skill of the anaesthetist. An adequate history and physical examination are essential before approaching this problem.…”

“…Cette question difficile a 6t6 revue pr6cemment en profondeur par Crosby et Lui. 43 La m(~thode optimale Parle selon les conditions des patients, le niveau de coop6ration, et I'habilet6 de I'anesth6siste.…”