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

Head Injury and Neuroanesthesia


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


Robitaille A (Centre Hospitalier de l’Université de Montréal, Quebec, Canada) Can J Anaesth 58:1125-1139, 2011§



S. Black, MD



Evidence Ranking


• B



Expert Rating


• 3



Abstract



Purpose


Securing the airway of a patient with a potentially unstable cervical spine (C-spine) is a complex and challenging task. The objective of this continuing professional development module is to review the current knowledge essential for airway management in the face of potential C-spine instability and, at the same time, to underline areas of uncertainty and limitations in the literature.



Principal Findings


In low-risk patients—defined by strict criteria derived from large multicentre studies—the C-spine can be considered stable or “cleared” without imaging. In all other patients, at least a thin-section computed tomographic examination of the spine from the occiput to T1 should be obtained, including sagittal and coronal multiplanar reconstructed images. Until the C-spine is cleared, it should be immobilized in the neutral position using a rigid cervical collar, sandbags, tape, and a backboard. During airway management, the anterior part of the cervical collar should be removed, and manual in-line stabilization should be applied. Some airway techniques, such as fibreoptic bronchoscopy and the Trachlight®, have been shown to induce less C-spine movement than direct laryngoscopy; however, the impact of such airway management on outcome is uncertain.



Conclusion


Adequate airway management in the patient with potential C-spine injury demands an understanding of C-spine anatomy, the criteria required to clear the C-spine, and the indications, techniques, and pitfalls of C-spine immobilization. When choosing an airway technique, minimization of C-spine motion should be considered, but the method of choice should also incorporate the broader clinical context (Table 2).


Table 2 Characteristics of Different Airway Techniques in the Patient with a Potentially Injured Cervical Spine (C-Spine)












Technique Characteristics
Basic airway maneuvres C-spine movement is comparable with or less than direct laryngoscopy.
Direct laryngoscopy (DL)
– ease of use

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Jan 28, 2017 | Posted by in ANESTHESIA | Comments Off on management in the patient with potential cervical spine instability: Continuing Professional Development

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