Airway Management in Cervical Spine Problems

Mary Adel Awadallah


Summary T he spectrum of anesthesia and airway management in patients with cervical spine problems is considerable. Whatever the patient will undergo spinal surgery such as spinal stabilization following trauma or neoplastic disease, or for correction of scoliosis, or even when the patient will undergo any surgery need intubation and have a problem in his cervical spine with risk in extending the neck as some autoimmune diseases such as rheumatoid arthritis, it presents a number of challenges, especially airway management which may be difficult. The cervical spine is made up of the first seven vertebrae in the vertebral column. It starts just below the skull and ends at the top of the thoracic spine. The cervical spine has a backward "C" shape and it is much more mobile than either of the thoracic or lumbar region. The cervical spine is designed to support the head and to permit maximal motion in three dimensions without damaging the spinal cord. The three axes of motion are: flexion/extension (floor to ceiling), lateral bending (shoulder-to-shoulder) and axial rotation (turning side-to-side). The range of cervical spine is very important in airway management.Cervical spine diseases can be classified intoautoimmune disease,inflammatory diseases, traumatic injuries degenerative diseases and neoplastic diseases. Choice of induction technique, i.v. or inhalation, is guided primarily by the patient's condition and by consideration of the ease with which the trachea may be intubated.A decision must be made at preoperative assessment whether to intubate the patient awake or asleep, and whether fibre-optic laryngoscopy will be required. The patient must be counseled fully about the decision at this time. Anesthesiaofthe airway is done either topically by 4% lidocaine spary + 0.25% phenylephrine nasal drops and anesthesia of the oropharynx and supra-glottic area by lidocaine spray which is introduced through the nasopharyngeal airway or the anesthesia can be done by nerve block to nerves which supply the airway. Intubation can be done by direct or blind techniques. Then the use of fiberoptic with its different techniques as with flexible tracheal tube, by use of LMA is done and doing jet ventilation by fiberoptic. Also in the oxygenation during intubation the use of jet ventilation is useful method in some cases. Finally, when intubation is failed by all thesemethods, the surgical techniques must be obtained as cricothyroidotomy and tracheostomy. Patients with difficult airway or with cervical spine problem interfere with the airway need careful extubation and it is preferred to be a fully conscious extubation.

Other data

Other Titles التعامل مع الممر الهوائى فى وجود مشاكل بالفقرات العنقية
Issue Date 2015

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