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Erschienen in:
01.12.2011 | Continuing Professional Development
Airway management in the patient with potential cervical spine instability: Continuing Professional Development
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2011
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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.