Segmental cervical spine movement with the intubating laryngeal mask during manual in-line stabilization in patients with cervical pathology undergoing cervical spine surgery.
ABSTRACT We quantified the extent and distribution of segmental cervical movement produced by the intubating laryngeal mask (ILM) during manual in-line stabilization in 20 anesthetized patients with cervical pathology undergoing cervical spine surgery. All patients had neurological symptoms preoperatively. The ILM was inserted with the head and neck in the neutral position. Intubation was facilitated by transillumination of the neck with a lightwand. Cervical movement was recorded with single-frame lateral radiographic images taken 1) immediately before induction (baseline); 2) during ILM insertion (insertion); 3) when transillumination was first seen at the cricothyroid membrane (intubation A); 4) when the tube was being advanced into the trachea (intubation B); and 5) during ILM removal (removal). Radiographic images were digitized and the degree of flexion/extension and posterior movement measured for the occiput (C0) through to C5. During ILM insertion, C0-5 were flexed by an average of 1-1.6 degrees (all P < 0.05). During intubation A/B, C0-4 were flexed by an average of 1.4-3.0 degrees (all P < 0.01), but C5 was unchanged. During ILM removal, C0-3 were flexed by an average of 1 degree (all: P < 0.05), but C3-5 were unchanged. During insertion and intubation A/B, C2-5 were displaced posteriorly by an average of 0.5-1.0 mm (all: P < 0.05). During removal, there was no change at C1-5. Neurological symptoms improved in all patients. We conclude that the ILM produces segmental movement of the cervical spine despite manual in-line stabilization in patients with cervical spine pathology undergoing cervical spine surgery. This motion is in the opposite direction to direct laryngoscopy, suggesting that different approaches to airway management may be more appropriate depending on the nature of the cervical instability. IMPLICATIONS: The intubating laryngeal mask produces segmental movement of the cervical spine, despite manual in-line stabilization in patients with cervical spine pathology undergoing cervical spine surgery. This motion is in the opposite direction to direct laryngoscopy, suggesting that different approaches to airway management may be more appropriate depending on the nature of the cervical instability.
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ABSTRACT: A young male, aged 32 years, was brought to the emergency operation theatre, with a household knife-in-situ, in the neck. A detailed history revealed psychiatric illness to be the cause of this self inflicted injury. His vitals were found to be stable and he had no respiratory embarrassment and was conversing comfortably. Intubating him with a knife-in-situ was a great challenge. A simple technique using two endotracheal tubes was used which helped in securing the airway avoiding any further injury with the knife-in-situ.09/2014; 31(1). DOI:10.1016/j.egja.2014.08.003
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ABSTRACT: Surgery on the cervical spine runs the gamut from minor interventions done in a minimally invasive fashion on a short-stay or ambulatory basis, to major surgical undertakings of a high-risk, high-threat nature done to stabilize a degraded skeletal structure to preserve and protect neural elements. Planning for optimum airway management and anesthesia care is facilitated by an appreciation of the disease processes that affect the cervical spine and their biomechanical implications and an understanding of the imaging and operative techniques used to evaluate and treat these conditions. This article provides background information and evidence to allow the anesthesia practitioner to develop a conceptual framework within which to develop strategies for care when a patient is presented for surgery on the cervical spine.Anesthesiology Clinics 10/2007; 25(3):511-33, ix. DOI:10.1016/j.anclin.2007.05.001
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ABSTRACT: Airway management in patients with cervical spine injury is a difficult and challenging task. Attention to head positioning and stabilization during the initial evaluation and airway management is critical in the care of these patients in order to minimize the risk of secondary neurologic insult. Awareness that these patients are at risk for airway obstruction is critical. A systemic approach and development of an individualized airway plan is necessary for optimal management of patients with cervical spine injury.09/2013; 3(3). DOI:10.1007/s40140-013-0022-9